Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 1
Welcome
We are glad you chose Owensboro Health for your cardiac procedures. We trust that you will be well pleased with the care you receive and that our service will meet your expectations.
Our Goal is Excellence - both with your personal and your clinical needs. Our patient-centered atmosphere emphasizes prompt and courteous service to you and your loved ones, while providing comprehensive and innovative treatment for your cardiac condition.
This packet of information is designed to be a resource to assist you and your family in preparing for your upcoming surgery. The information will be reviewed with you before and during your hospitalization. This binder can then be taken home with you to further assist in answering questions you may have about your recovery. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 2
For your convenience we would like to Cafeteria and Vending Areas: provide the following information... • For your convenience, there is a vending area located on Telephones and Numbers: the 2nd floor nearing the waiting area. Telephones are located in the visitors waiting area. • We serve three meals each day in the cafeteria located Commonly used numbers are: on the 1st floor Owensboro Health ...... (270) 417-2000 Breakfast 5:30 a.m. until 10:30 a.m. Chaplain ...... (270) 417-2100 Lunch 11:00 a.m. until 2:00 p.m. Cashier Owensboro Health ..(270) 417-6639 Dinner 4:00 p.m. until 6:45 p.m. Cashier at Business Center ....(270) 685-7598 • The grill and Subway located inside the cafeteria are also Patient relation Specialist ...... (270) 417-4350 open from 11:00 a.m. until 11:00 p.m...... or 4351 Case Management ...... (270) 417-4600 Visiting Hours for Volunteer Services ...... (270) 417-3100 Open Heart Recovery: Critical Care Unit ...... (270) 417-2200 Once your family member has been moved to the Progressive Care Unit...... (270) 417-2300 Critical Care room and their condition has stabilized, you will be allowed to see them for a brief period. This is not a visiting time as your family member most likely will still Accommodations: be asleep from the anesthesia. Overnight Accommodations After the initial recovery period visiting will be based on For a small fee, Hospitality Suites are available to the patient’s condition. Visitors are limited to 2 at a time accommodate overnight family members. Please call and must be at least 13 years of age. Hospital staff are Guest Relations at (270) 417-3120 or stop by the present to assist you with your visit. Please check-in with main lobby information desk for availability. guest relations before entering the unit to see your loved one. Use the intercom outside the door or call from the Some of the area hotels located within minutes of the waiting room to announce your arrival. The station hospital, have made special rate accommodations phone number (270) 417-2200. available to out-of-town families of Owensboro Health patients. Please remember that your loved one will need plenty of rest during the initial recovery phase. Quiet healing time Each requires a form to be completed by the nursing takes place between 10:00 p.m. and 6:00 a.m. The nurse staff for the family to receive special rates. These forms may initiate additional quiet healing time as needed. are available from a member of the Critical Care Visitors are encouraged to wash hands upon entering nursing staff, from the hospital chaplain or patient AND leaving the room. For your convenience hand greeter at the unit sign-in desk. washing foam canisters are mounted in each patient room as well as the waiting area. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 3
Your Open Heart Surgery Team
Cory Davenport PA-C,
Dr. Doug Adams, MD
Cardiothoracic Surgery 1301 Pleasant Valley Road, Suite 201 Owensboro, KY 42303
Office Phone: (270) 417-7500 Office Fax: (270) 417-7529 Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 5
Coronary Arteries
The heart muscle, like every other organ or tissue in anterior descending artery and the circumflex artery, your body, needs oxygen-rich blood to survive. Blood is supplies blood to the left side of the heart. The left supplied to the heart by its own vascular system, called side of the heart is larger and more muscular because coronary circulation. it pumps blood to the rest of the body.
The aorta, the main blood supplier to the body, branches off into two main coronary blood vessels also called arteries. These coronary arteries branch off into smaller arteries, which supply oxygen-rich blood to the entire heart muscle. The right coronary artery supplies blood mainly to the right side of the heart. The right side of the heart is smaller because it pumps blood only to the lungs.
The left coronary artery, which branches into the left Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 6
Your Heart
When the heart is healthy there is: • A strong heart muscle that pumps well • Normally functioning valves that help direct blood flow • Open coronary arteries that allow oxygen and nutrients to get to the heart muscle
The heart is a pear-shaped muscle about the size of a The heart, as a muscle, also needs oxygen and nutrients to fist and typically weighs less than a pound. The heart work correctly. The heart receives its blood supply through muscle sits in the middle of your chest just to the left small blood vessels (coronary arteries) that are on the heart's of the breastbone. surface. These coronary arteries divide into several branches and deliver oxygen to all areas of the heart muscle. The heart muscle pumps blood, which carries oxygen and nutrients, nonstop, to the head and body. The heart is made up of four chambers that work together to regulate the flow of blood.
The two top chambers are called atria and the bottom two are called ventricles. The atria collect blood that returns to the heart and assists in moving the blood to the ventricles. The ventricles are larger and more muscular – especially the left ventricle.
When the ventricles contract or squeeze they pump the blood out of the heart to the different parts of the body. The right side of the heart is receiving blood from the body that is low in oxygen – because it has been used by the body – and pumps this blood to the lungs to pick up more oxygen. The left side of the heart receives blood rich in oxygen from the lungs and pumps it out to the body.
The flow of the blood through the inside of the heart is assisted and directed by the heart valves. Valves basically make sure that the blood flows in a forward direction. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 7
Heart Disease
You may have heard the terms heart disease or coronary artery disease (CAD). Either of these terms refers to atherosclerosis, which is the build up of fatty deposits and calcium inside the blood vessel walls. When this occurs inside the arteries that provide blood to the heart muscle itself, it is called "coronary atherosclerosis". When the build up inside the arteries blocks a significant amount of the flow, the heart muscle becomes deprived of oxygen and nutrients that are needed for normal function.
A Healthy Artery Blood flows smoothly When the inner lining of a coronary artery is through a healthy coronary artery, healthy, blood flows through the heart easily. This bringing oxygen to your heart gives your heart muscle the oxygen and other muscle. nutrients it needs. Even during activity, healthy Healthy heart muscle arteries can meet your heart’s increased demand for oxygen.
A Damaged Artery Blood flow to the heart muscle The inner lining of the artery can be damaged by high is slightly reduced if the inner blood cholesterol, high blood pressure or smoking. This lining of a coronary artery is leads to a buildup of plaque (fatty substances and damaged. calcium) within the lining of the artery. Blood may no longer flow easily to the heart muscle. This is the beginning of coronary artery disease.
A Narrowed Artery Blood flow to the heart muscle If plaque buildup increases, the artery narrows and is severely reduced when plaque blood flow to the heart muscle is severely reduced. builds up within the walls of a Your heart becomes starved for oxygen, which may coronary artery. cause angina. Oxygen-starved heart muscle.
A Blocked Artery Blood flow to the heart muscle You may have a heart attack (myocardial stops when a blood clot blocks a infarction) if blood flow is completely blocked by narrowed coronary artery. a blood clot in the narrowed artery. Without oxygen-rich blood, some of the heart muscle is permanently damaged. Permanently damaged heart muscle. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 8
Myocardial Infarction – Heart Attack
Every year hundreds of thousands of people suffer from heart attacks. A number of these people will die. Because studies have shown that knowing more about your heart and heart attacks may save your life, we are providing this information for you.
What happens when you have a What are the warning signs of a heart heart attack? attack? A heart attack – sometimes called a myocardial Now that you have some idea of what a heart attack is and infarction – happens when the blood and oxygen what causes it, you need to know what the warning signs of a supply does not get to part of the heart. heart attack are.
Without blood and oxygen, that part of the heart Most heart patients will survive if they learn the early starves and dies. Heart damage occurs when the blood warning signals of heart attack and get medical help at flow through a coronary artery or arteries is blocked. once. The pain of a heart attack is not the same for every This blockage can be caused by coronary artery spasm, person. It may be very painful for one person and milder for bloodclots, or atherosclerosis or "hardening of the another. Sometimes people feel that they only have arteries". indigestion. Signs and Symptoms Symptoms of abnormal heart function can be Many times, heart attack victims wait to get help. Some different for different people. Some people will people do so because they are afraid to admit they are ill. develop "angina" or chest pain that may extend into Other people just do not know what the symptoms or signals the arms, neck or jaws and may or may not have mean. Many times, the symptoms are ignored in hopes the shortness of breath. This chest pain may be pain will go away. described as burning, squeezing, heaviness or "gas" pain. We encourage you to seek medical Other people may have shortness of breath, but very help immediately if you have any of the little pain - more likely in diabetics and women. In following indicators: earlier stages of heart disease these symptoms may occur when you are exerting yourself with physical Signals for every person are different, but the usual activity. As the heart disease progresses the symptoms warnings of a heart attack are: may begin to occur more often, be stronger and take • Uncomfortable pain, pressure, fullness, or squeezing less activity to cause the symptoms to occur. feeling in the center of the chest for more than two If a coronary artery becomes blocked so severely that minutes. there is no blood flow to that area of the heart, that • Pain that spreads to the jaw, shoulders, neck or arms area of the heart muscle may become severely • Dizziness or faintness damaged. That condition is known as a myocardial • Weakness infarction or "heart attack". There is additional • Sweating information in the next few pages that discusses a heart • Nausea or vomiting attack and the risk factors for developing heart disease. • Shortness of breath or difficulty with breathing Once heart disease is suspected, there are many • Pain that is not relieved with rest or medication diagnostic tests used to determine the exact problem, (such as nitroglycerin) the extent of the problem and the best treatment. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 9
Coronary Artery Bypass Surgery
The Coronary Arteries lie on the outside of the heart and supply the heart muscle with oxygenated blood.
Coronary artery bypass surgery is one method used for treating coronary artery disease. In this procedure a large vein from your leg, called the saphenous vein, is removed. This vein may be divided into sections and used for more than one bypass.
One end of this vein is attached to the aorta and the other end is connected to the coronary artery below the area that is blocked. This allows the blood to bypass the blocked area and supply more blood to your heart muscle.
In some cases the internal mammary artery or the radial artery is used to bypass the blocked area. The internal mammary artery is an artery found in the chest wall and the radial artery is found in the arm. Your doctor will determine if these arteries are to be used during surgery. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 10
Beating Heart CABG Surgery
Beating Heart Coronary Artery Bypass Surgery
Beating Heart Surgery allows the heart to continue beating while the surgery is performed. This procedure/surgery incorporates state-of-the-art technology of a heart-stabilizing device. The stabilizing device immobilizes a small section of the heart that needs the bypass graft while the rest of the heart muscle continues to beat and pump blood to the body.
Potential Advantages of Beating Heart Surgery
Beating heart surgery eliminates the need for the patient to be put on the heart-lung machine (pump). Recent clinical studies have suggested that the following are potential benefits to the patient:
• Shorter length of stay: some patients are discharged from the hospital in 2-3 days versus the typical 7 to 10 days for conventional CABG surgery.
• Faster recovery: Patients are returning to their normal activities in 4 weeks rather than the typical 6 to 8 weeks with conventional surgery.
• Less damage to blood cells: The use of the heart-lung machine damages blood cells, which may affect the blood’s ability to clot after surgery. Without the use of the heart-lung machine, the blood is not exposed to this potential damage.
• Shorter surgery time: The patient may spend about one hour less in the operating room; and may be removed from the breathing machine sooner.
• Better outcomes: Patients may have less risk of complications after surgery such as stroke, pneumonia or kidney problems. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:54 PM Page 11
Minimally Invasive daVinci® Heart Surgery
Advanced Surgical Technique offered at OWENSBORO HEALTH – A new approach to treat Cardiothoracic Conditions such as coronary artery disease and mitral valve prolapse
Using specialized hand controls the surgeon performs the surgery from a console at the bedside
What is da Vinci Surgery?
Benefits of using da Vinci Surgery for cardiothoracic procedures • No need for a sternotomy (an 8-10 inch incision through the breastbone) • Reduced risk of surgical complications • Higher long-term survival da Vinci Surgery involves using a robotic system to allow the surgeon to perform the surgical procedure • Shorter hospital stay and faster recovery through minimally invasive surgical sites. If you are a • Less pain and scarring candidate for this procedure, your surgeon may offer • Less blood loss or need for blood transfusions robotic surgery as an option.
Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits. While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 12
Transmyocardial Revascularization (TMR)
Transmyocardial Revascularization (TMR) A new approach to treatment of Chronic Angina
Angina Pectoris Angina Pectoris (Angina) is a medical term used to describe chest pain resulting from coronary artery disease. All cells, muscles, and tissues in your body need the oxygen carried in your blood. If blood vessels, which bring blood to the heart muscle (the body's main blood pump), are clogged or damaged, the heart muscle does not receive the oxygen it needs. As a result, you may feel a pain called angina. Angina pain may be felt in your chest, neck, jaw back, shoulders or arms. The pain can be mild to severe and may even be disabling. What is Transmyocardial Revascularization? Transmyocardial revascularization (TMR) is precise laser therapy is used to create small channels into the heart chamber which stimulate the heart muscle to create new blood vessels.. TMR delivers precise laser energy directly to the target area(s) of the heart muscle. When performed as a sole therapy, it is done through a small incision between the ribs (thoracotomy) with the patient under general anesthesia. TMR can also be performed as a complement to bypass surgery in patients that have areas of ischemic heart disease that cannot be bypassed.
TMR Procedure During transmyocardial revascularization (TMR), the surgeon uses one of the flexible, fiberoptic handpieces to deliver precise bursts of laser energy directly to an area of heart muscle that is suffering from ischemic heart disease. The surgical procedure is performed through a small incision or small ports with the patient under general anesthesia, During a typical procedure, approximately 20-40 channels are made in the heart muscle of a beating heart.
The outside punctures seal over immediately with little blood loss while the new channels allow fresh blood to perfuse the heart wall immediately, and may provide oxygen in the process. Your surgeon will determine the number of channels to be placed and where they should be located. Your doctor will discuss all the risks and benefits of surgery and the TMR procedure with you. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 13
Transmyocardial Revascularization (TMR)
“Angina usually subsides with improved oxygen supply to the targeted areas of damaged heart muscle.”
How Does TMR Work? At this time it is not fully understood how TMR relieves angina:, although there are several theories that are under investigation for the way in which TMR works including:
• Directly increasing the blood flow to the heart muscle.
• Stimulating the growth of new small blood vessels within the heart muscle.
• Reducing pain by impairing the nerves and/or placebo effect.
TMR May Not Be Indicated:
For You if:
• You are unable to undergo general anesthesia. • You have had a heart attack (myocardial infarction) within three weeks. • You have uncontrollable or severe heart rhythm problems. • You have debilitating chronic lung disease, such as chronic obstructive pulmonary disease, which significantly impairs your ability to breathe. • You have heart failure, also known as congestive heart failure, usually associated with shortness of breath due to "fluid in the lungs" or with swelling in the lower extremities.
TMR May Benefit You TMR may benefit you if there is an area of your heart that is not receiving enough oxygen and your disease cannot be treated by balloon angioplasty or bypass surgery
• TMR has been proven to reduce angina pain and improve the quality of life in patients with coronary artery disease. • Treatment with TMR may help you return to a more active lifestyle. • Treatment with TMR may also reduce the need for some of the medications you are currently taking to manage your angina pain.
What Follow-Up Will I Receive? Your follow-up requirements for recovery after a TMR procedure are similar to those following other heart surgeries. You will undergo regular check-ups by your physician.Your physician will advise you when you may return to your normal activities. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 15
Heart Valves
Heart valves are structures inside the heart that act as doors to keep the blood flowing in the right direction through the heart. You have four valves: Tricuspid valve Mitral valve Pulmonic valve Aortic valve
Four types of valves regulate blood flow through your heart:
• The tricuspid valve regulates blood flow between the • The mitral valve lets oxygen-rich blood from your lungs pass right atrium and right ventricle. from the left atrium into the left ventricle. • The pulmonary valve controls blood flow from the • The aortic valve opens the way for oxygen-rich blood to pass right ventricle into the pulmonary arteries, which from the left ventricle into the aorta, your body's largest carry blood to your lungs to pick up oxygen. artery, where it is delivered to the rest of your body. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 16
Valvular Heart Disease
Who gets a diseased valve? How do you know if you have valvular Anyone can develop a diseased heart valve. Valvular heart disease? heart disease is more common in older people, but Many people with diseased valves do not feel anything unusual. babies can be born with valves that do not function However, when valvular heart disease is more severe, you may properly. tire easily, experience shortness of breath after exercise, develop bronchitis frequently, and suffer from chest pains (angina) and How do you get valvular heart fainting spells. disease? Doctors can often detect a diseased valve by listening to the Heart valves can be defective from birth. Valvular heart heart sounds. A diseased valve makes a distinctive noise called a disease can result from aging, heart attacks, infections, heart murmur. If a murmur is heard, doctors can do special or other disease processes that affect the circulatory tests that take pictures of the heart valves to examine them system. more closely. These tests help the doctor determine the cause of Which Valves Are Affected? the symptoms and, if valvular heart disease is present, the best treatment for the disease. Any valve can develop a problem. But problems are most common with the aortic and mitral valves. What are the risks of valvular heart Tricuspid and pulmonic valve problems are less disease? common. Many people live happy and productive lives with diseased heart valves. However, one risk associated with valvular heart disease is that a blood clot may form on the diseased valve. Other risks include an enlarged heart leading to impaired blood How are people with valvular flow, a failure of the heart to pump blood effectively, and an irregular, rapid contraction of the atria called atrial fibrillation. heart disease treated? Treatment for diseased heart valves can be medical or surgical. Medical treatment can improve heart function and help prevent complications. Sometimes, a valve is so diseased that it requires surgical treatment. Occasionally, the surgeon must examine the valve to determine whether it is repairable or if it needs to be replaced. Operations to replace diseased heart valves have become common procedures.
Replacement valves can be mechanical or biological. Mechanical valves are often made of carbon and other suitable material. Biological valves often come from pigs and cows, and are very similar to human heart valves. Each type of valve has its advantages and disadvantages. Your surgeon will determine the right type of valve for you. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 17
Valvular Heart Disease
What is Valvular Heart Disease? Blood flow through the heart's four chambers (two atria and two ventricles) is controlled by four valves. The valves keep blood from flowing backwards. Sometimes the valves don't function properly. This is called valvular heart disease. Problems occur when the valve doesn’t open or close the way it should. The two valves most commonly affected by valvular heart disease are the aortic valve and the mitral valve.
Problems Opening (Stenosis) Problems Closing When a valve doesn’t open all the way, the (Insufficiency) problem is called stenosis. Scarring or When the valve doesn’t close tightly, the deposits of calcium may make the valve stiff problem is called insufficiency (or and hard to open. If the valve doesn’t open the way it should, blood has to flow through regurgitation). The valve may have extra a smaller opening. The heart muscle then has tissue or be loose or shortened. Or the to work harder to push the blood through. structures that support the valve may be Over time, stenosis can get worse. torn. A valve that doesn’t close tightly lets blood leak backward through the valve. The heart has to move some of the same blood over again. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 18
Valvular Heart Disease
What are the risks of a Subacute Bacterial Endocarditis replacement heart valve? (SBE) A common risk is a blood clot forming on the Persons who have heart valve surgery are at increased replacement valve. If a piece of the clot breaks off, risk of developing bacterial infections of the heart. This there is the danger that it may clog an artery that is usually caused by bacteria that enter the bloodstream supplies blood to the brain. This can cause a stroke. during illness, dental work or other procedures Or, the blood clot can clog an artery that supplies performed by doctors and dentists. blood to other organs, such as the kidneys. It is your responsibility to inform your doctors and Your doctor will prescribe medication to prevent clots dentists that you have had heart valve surgery. To from forming. People who have mechanical heart prevent subacute bacterial endocarditis you will need to valves will need this medication for the rest of their be placed on antibiotics prior to most medical lives. People with biological valves may only need to procedures and dental work - including routine teeth take medication for a short time following surgery. cleaning. Also, you should notify your doctor of cold or flu symptoms so you maybe placed on antibiotics.
Coumadin® Your responsibilities: Patients who have a man-made heart valve must take a Valvular heart disease can be serious, but it can be medication to prevent blood clots from forming treated. Be sure you understand all of the risks and around the valve. This medicine, called Coumadin®, is responsibilities involved before you begin any often referred to as a blood thinner. In fact, it does not treatment. It's also very important that you visit your thin the blood, but it decreases the blood's ability to doctor as scheduled. clot. Any questions? Be sure to ask your doctor. Since you will be taking Coumadin® for the rest of your life, it is recommended that you wear a Medic Alert® identification bracelet.This will let others know you are a Coumadin® patient. Before going home your nurse will be giving you additional information regarding Coumadin®. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 19
Heart Valve Surgery
The following information is for patients who have had heart valve repair or replacement surgery:
Special Diet: Important Things to Remember:
Patients with valve replacements or valve problems may All other doctors, including dentists must be aware that retain excess body fluid. A salt or sodium restriction you have had heart valve surgery. This is very important diet may be prescribed by your doctor. Excess water especially if you are taking an anticoagulant (blood gain is usually identified by a rapid weight gain, 3-5 thinner). You should also receive antibiotics before having pounds in a week, which is not explained by over- any of the following: eating. Other symptoms are unusual shortness of breath, swollen ankles, swollen hands or enlarged • Any dental work – this includes cleaning abdomen. These symptoms should be reported to your • Any major surgery doctor. • Minor surgeries • Procedures which cause trauma to body tissues.
Medications: Bacteria can be released into the bloodstream during these times and lodge in the inner lining or the valves. This Your doctor has prescribed medications specifically for causes an infection called subacute bacterial endocarditis. you. These may differ from the medications you took This infection can scar or even destroy the new valve. before surgery. Remember to follow the instructions Taking antibiotics can reduce your risks. for taking the medications exactly.
You may be taking an anticoagulant or "blood What to Report to the Doctor: thinner." The dosage for this medicine will be adjusted according to blood tests ordered by your doctor. Do • Temperature greater than 100.0 F. not change dosages or miss dosages unless your doctor • Chills tells you to do so. Please refer to the medication section • Flu like symptoms lasting longer than one week of this book for information on • Excessive bleeding from minor cuts anticoagulants/Coumadin. • Signs of bleeding of any kind Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 20
Endocarditis
What is endocarditis? Endocarditis is an infection of the inner wall of the heart. It starts out as a usually harmless infection called bacteremia, which is caused by various bacteria. These bacteria enter your body like any other infection, through cuts, food you eat, and especially dental work and poor oral hygiene. Your body usually controls these infections, but bacteria that grows out of control can turn into endocarditis. This happens more easily if you already have heart disease.
In endocarditis, bacterial growth gathers around your heart valves, interfering with blood flow. The growth can break off and form blood clots, which can travel to other parts of your body and can block blood flow and cause serious problems. Endocarditis can permanently damage the tissue and valves in your heart.
How is endocarditis treated? Take these simple precautions: Since endocarditis can be so serious, you will be kept in • See your doctor regularly for follow-up the hospital until the infection is gone, often as long as a care of your heart. month or more. You will be given some medicine to fight • Remind your doctor to give you antibiotics the infection, mainly antibiotics, which are introduced if you will have blood tests, surgery, and right into your blood system through a vein. Blood tests any internal examinations whatsoever. will be taken to identify the bacteria so that the best antibiotic can be chosen. You will probably get aspirin to • See your doctor immediately if you think relieve flu-like aches and fever, and you may get other you have any kind of infection, especially medicine to dissolve clots. More blood tests will be taken infections of the sinuses, throat, lungs, bladder, kidney, vagina, or skin. from time to time to make sure the medicine is working. • Visit your dentist every 6 months for You should rest so that your heart can rest. You should eat preventive care. well to help your body heal. This is especially important because you may not have much of an appetite. • Make sure your dentist knows you have had endocarditis and make sure you take After you recover antibiotics whenever you have a tooth pulled, whenever the dentist works on Once you've had endocarditis, you will always be at risk your gums, and whenever you have your for getting it again. You should make some minor changes teeth cleaned. of habit to help make sure you don't get it again. • Practice good oral hygiene and brush your The best way to prevent endocarditis from coming back is teeth after meals. to control the bacteria entering your body, especially • Never use unwaxed dental floss, since this during medical and dental procedures, when you have a can more easily cut your blood-rich gums. cut, and anytime your body is directly exposed to the outside world. Whenever you visit your doctor or dentist, • Always see your dentist immediately if you make sure you tell them you have had endocarditis. If have a toothache or think you might be they will be doing anything that puts them in direct getting an abscess. Always take your contact with your blood or might break your skin, they complete prescription of antibiotics, even should give antibiotics beforehand, and you should after you feel better. remind them. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 21
Preparing for Surgery
What you will need to have done before surgery •You should have the necessary pre-op work up completed. •If you are taking any blood thinners. (i.e. Coumadin, Ticlid, Plavix, aspirin, etc.) Your surgeon may want to have you stop them prior to your surgery date. •You are scheduled for pre-op testing on ______.
The days before surgery • Call your surgeon if you have a cold, fever, infection, or other illness. (270) 417-7500. • Do not drink alcoholic beverages 24 hours prior to your procedure and avoid heavy spicy foods. • You are advised to stop smoking prior to surgery to facilitate respiratory recovery as well as wound and bone healing.
The night before surgery •You may eat a normal meal the evening before your operation, but DO NOT EAT, DRINK OR CHEW ANYTHING AFTER MIDNIGHT. This includes gum,mints, Lifesavers, water or tobacco. •Remove all fingernail and toenail polish. If you wear acrylic or artificial nails you are advised to have them removed prior to you surgery as they harbor bacteria and may increase your the risk of a surgical wound infection. •Take a shower using your personal care products, then using the antibacterial soap provided, take another shower or bath following the instructions described in this packet. •Perform good oral care including antiseptic mouth wash. Gargle and rinse mouth and throat a full 30 seconds at bedtime. •Retire early and make an effort to get a good night sleep.
The day of surgery •Proceed with your morning routine shower and care. •When brushing your teeth avoid swallowing any water. Perform good oral care including antiseptic mouth wash. Gargle and rinse mouth and throat a full 30 seconds. •Again wash with the antibacterial soap as you did the night before. (Instructions are included in this book). •Women should not wear any makeup. •Take your heart and/or blood pressure medications alone with any medicines for seizures, thyroid, stomach problems, breathing issues, or medication to control heart rhythm with a sip of water only. Come to the hospital empty, without food or drink. • Plan to arrive at the hospitals main entrance at least 2 hours before your scheduled procedure. Arrive by ______. • Take the elevator located in the front lobby to the 2nd floor. Exit to the right and check-in at the Surgery Waiting Desk. •We recommend dressing comfortably, in easy to fold clothing. A personal belonging bag will be provided so your clothing can be given to a member of your family, or a friend. •Be sure to leave all jewelry, watches, money, and other valuables at home or with the person who accompanies you. •You may use your personal robe and toiletries once transferred to the floor, however do not bring them with you the day of surgery. •The AM of surgery your blood sugar will be checked and an insulin drip will be started if needed on both diabetic and non diabetic patients to maintain tight control of blood sugar levels. More can be found about blood sugar control under the After Surgery Tab of this book. •Female patients should bring 2 (two) good supportive bras that are front closing to the hospital to wear after surgery. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 22
Preparing for Surgery
Preoperative Showering Instructions It is extremely important to prepare your skin before surgery. By cleaning your skin with special antibacterial soap, you will decrease the risk of postoperative wound infection. You will need to take a shower using this soap the night before and the morning of surgery. Instructions on how to use this soap are listed below:
The soap is for external use only. Avoid getting suds in your eyes. If this occurs, rinse promptly and thoroughly with water.
1. Take a shower with your own soap and shampoo products
2. Next wash your entire body with one ounce of the antibacterial soap.
3. Last pour one ounce of the antibacterial soap on a clean wash cloth and scrub your entire chest from neck to waist and both legs from groin to ankle for at least five minutes.
4. Rinse the soap off.
5. After you have washed the second time, pat yourself dry with a towel. Do not rub yourself with the towel. Do not use deodorant, creams, lotions, aftershaves or powders on your skin after your scrubs.
6. REPEAT THE ABOVE PROCESS THE MORNING OF SURGERY.
The morning of surgery, you will have your chest and legs shaved (chest only for valve surgery).
It is very important to use proper hygiene and hand washing before and after surgery. This helps prevent infections. If you have any questions regarding how to properly do this, please ask your nurse for assistance.
Preoperative Bactroban Instructions: If the preoperative nasal swab culture is positive for MRSA you will be asked to follow the instructions below:
• If you have a positive culture of MRSA, swab Bactroban ointment gently inside each nostril with Q-tip three times a day for the three days just prior to your surgery date.
• Do not use if allergic to Bactroban. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 23
Preparing for Surgery
YOUR DOCTOR WILL WANT YOU TO USE A BREATHING AID CALLED AN INCENTIVE SPIROMETER AFTER SURGERY. This device encourages you to breathe deeply and will help keep your lungs free of congestion as you recover. It also provides feedback to show you how well you are doing.
This is how you should use the incentive spirometer:
1. Sit up as straight as you can to help your lungs to fully expand. Hold the mouthpiece with one hand and the spirometer with your other hand. Position the spirometer in front of you.
2. Slide the pointer of the spirometer to prescribed volume level. Hold or stand the spirometer in an upright position.
3. Breathe out normally. Then place lips tightly around mouthpiece.
4. Breathe in slowly to raise the piston in the chamber. While breathing in, maintain flow range.
5. Continue breathing in and try to raise piston to prescribed level. When inhalation is complete, remove mouthpiece, hold breath as prescribed and breathe out normally. Allow piston to return to bottom of chamber, rest and repeat exercise.
AFTER SURGERY, YOU WILL BE GIVEN A SPIROMETER. YOU WILL BE ASKED TO USE THE SPIROMETER 10 TIMES EVERY 2 HOURS WHILE YOU ARE AWAKE AND IN THE HOSPITAL. YOU WILL NEED TO TAKE THE SPIROMETER HOME AND USE FOUR TIMES A DAY FOR THE FIRST TWO WEEKS AT HOME. This breathing exercise is extremely important in helping you to recover and to go home. If you are in pain while you do this, please ask your nurse for pain medication.The nurses and respiratory therapists may remind you to do your breathing exercise, but do not wait for them to start the exercises. You will be expected to do the breathing exercises on your own. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 24
The Operation
• The details of your operation will be discussed with you and your family by your heart surgeon and nurses who are specially trained in cardiac care.
• Please keep in mind your surgery will be completed while you are in a deep sleep, under a general anesthesia. The anesthesiologist will discuss this with you before your operation.
• Your surgery may take from three to five hours depending upon the type of surgery required and the method used by the heart surgeon.
• Your Cardiac Surgery is scheduled for______a.m./p.m. On______Please plan to be at the hospital by______
Family and Visitors Information
• If you have additional family members coming and you want to visit them before surgery, they will need to be at the hospital 2 hours before your scheduled surgery time.
• When its time to go to surgery family members will wait in the 2nd floor waiting area.
• Visitors should check in at the volunteer desk, but feel free to move about for meals. Leave one family member in the waiting room, or a cell phone number where they may be found in the event someone needs to be reached.
• When the surgery is over the physician will come out and talk to the family. After talking to the physician family will have time to get something to eat before being allowed to visit.
• Someone from surgery will update the family at intervals through out the procedure.
• Family and significant others will be allowed to visit when the open heart recovery period is complete. The first visit will be brief approximately 1 1/2 to 2 hours after talking to the physician. Once the recovery period is complete family/significant others will be able to visit more frequently as the patient’s condition allows. The nurse will assist in determining what is appropriate. This will be a time for much needed rest. No more than 2 visitors may visit at one time. Visitors will need to be mindful not to over extend visiting and exhaust the patient with long or loud visits. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 25
Post-Operative Information
Bypass and Valve Surgery Recovery This information is intended to provide you with a brief overview of the recovery process after heart surgery. Each individual patient responds and recovers from surgery differently. You are unique! And recovery from each specific surgical procedure, whether a coronary artery bypass for clogged arteries or a valve repair/replacement for a narrow or leaky valve, is somewhat different as well. Despite these differences, however, some generalizations can be made.
The Society for Thoracic Surgeons (STS) also has a web site to help answer questions so that you may better know what to expect in your recovery. For general information about bypass and valve surgery, you may visit their website at www.sts.org. You will be provided details that are specific to your care and your individual situation before and after your surgery.
The Immediate Recovery • After your operation you will be taken directly to Critical Care area located on the second floor.
• As you begin to wake up after surgery you will be connected to several monitors that allow us to continuously check your heart rate, blood pressure and other important information reflecting how well your heart is functioning.
• The nurses in the Critical Care are specially trained in heart surgery recovery and will guide you through the recovery process.
• When you are recovered to a point you no longer require intensive monitoring, you will be moved to the Progressive Care Unit located on the 3rd floor. You will remain there until you discharge home.
• You should expect to stay in the hospital from three to seven days after surgery, however this will depend on the speed of your recovery and your overall health before surgery. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 26
Post-Operative Information (Continued)
The following devices and treatments will most likely be used in your recovery
• Breathing Machine – will maintain your • Monitoring – several monitoring devices will be used in breathing while recovering from anesthesia.The the recovery area allowing the doctors and nurse to breathing machine will be removed once you continuously evaluate your progress. begin to wake up from the anesthesia. • IVs – When you awake from surgery, you will notice • Incentive Spirometer/Coughing and Deep several IVs have been inserted in order to give you fluids, Breathing – As you were instructed in the Pre- medications and to monitor your blood pressure and Admission Testing session, once you are more heart pressures continuously after surgery. The IVs also awake it is important to take deep breaths. Lung allow the nurses to draw blood for necessary blood work, complications are one of the leading causes of eliminating the need for multiple needle sticks until they prolonged hospitalization and readmission to the are removed. hospital after surgery. In an effort to decrease the risk of these complications, we will be asking you • Bladder Catheter – A rubber-like catheter will be placed to use a breathing exercise machine called an in your bladder in order to drain your urine incentive spirometer. In addition to using the continuously. You may have a slight sensation to pass incentive spirometer every 2 hours while you are your urine when you wake up, however your urine will awake, we will also be asking you to do some pass continuously without effort on your part. coughing and deep breathing exercises. Staff from the OHR and Respiratory Care will encourage • Activities – Early ambulation is one of the key factors in you to do so frequently. a speedy and complication free post operative period. The following is the activity schedule we have developed • Chest Tubes – tubes placed in the operating for the patients who have heart surgery. room around the outside of your heart to allow drainage after surgery. You will notice these tubes Starting on the day following surgery, we will have you sit at the bottom of your incision. up in a chair for all meals. (Those meals will start out light and will advance as you tolerate.) We will also be • Pain Management – Pain Management is a vital walking you to the bathroom and around in your room. part of your postoperative course. Pain medication will be ordered for you every 4 hours as needed. On the second day after surgery, the chest tube will likely This means that the medication is available for be removed. We will assist you in walking in the hall. you but you must ask for it. We recommend that Our goal for walking on this day is at least 4 times. for the first 2 days, you take the pain medication every 4 hours. This will provide pain control that On the third day after surgery, we will sit you up for all is necessary to allow you to perform all the meals and walk you in the halls at least 6 times. We will activities required for a speedy recovery. After the have you continue this routine everyday until you are second day, you can begin extending the time discharged from the hospital. You will also be assisting between pain medication to suit your individual with your bath and personal care. needs. Every attempt will be made to keep you as comfortable and safe as possible during your recovery process. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 27
Post-Operative Information (Central Line Infections)
Central Line Infections types of central lines. Tunneled catheter: This catheter is A central line, such as a triple lumen catheter, is a soft tunneled through the soft tissue under the skin before it tube placed in the vein in your arm. It ends in a major enters a vein. It also has a small cuff that helps hold the vessel just above the heart. In the hospital, you may catheter in place. Both the tunnel and the cuff help have a small, soft tube placed in a vein in your arm, prevent infection. neck, or chest. Port: This is a central line (also called a venous catheter). It’s This is a small device that is placed under the skin on the often used when medications or nutrition need to arm or chest. The port is connected to a catheter that be given over a period of weeks or months. Having runs through a large vein near the heart. Infections can a central line means that you won’t need an IV develop inside the catheter or around the port. (intravenous) line. But central lines can cause What Causes Central Line Infections? certain problems. One such problem is infection. A central line is needed for your treatment. But a central This occurs when germs get into the catheter site line can also act as a pathway for germs into your body. or in your bloodstream. A bloodstream infection Often, the germs that cause a central line infection come can make you very ill and can even be fatal. This from your own skin. info tells you more about central line infections, what What Are the Risk Factors for a Central Line hospitals are doing to prevent them, and how they are Infection? treated if they do occur. Anyone who has a central line can get an infection. Types of Central Lines The risk is higher if you: Peripherally inserted central catheter (PICC • Are in the intensive care unit. line): • Have a weakened immune system or serious illness This line is placed in a large vein in the arm, near the • Are receiving bone marrow or chemotherapy. bend in the elbow. It’s then threaded through the vein • Have the line in for an extended time until the tip sits in the large vein just above the heart. It • Have a central line in your neck or groin can also extend into the heart. A PICC line has a low What Are the Symptoms of a Central Line risk of infection. Infection? Subclavian line: • Redness, pain, or swelling at or near the catheter site This line is placed through the • Pain or tenderness along the path of the catheter skin directly into the subclavian vein, which runs • Drainage from the skin around the catheter behind the collarbone. A subclavian line has a • Sudden fever and chills lower risk of infection than a jugular or femoral How Are Central Line Infections Treated? line. Treatment depends on the type of catheter, how Internal jugular line: severe the infection is, and your overall health. This line is placed into the internal jugular vein (a large Your doctor will prescribe antibiotics to fight the vein in the neck). infection. The line may also need to be removed. In some cases, the line is flushed with high doses of Femoral line: antibiotics. This may kill the germs causing the This line is placed in a large vein in the groin. A infection so the line doesn’t have to be removed. femoral line has a higher risk of infection than other Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 28
Post-Operative Information (Central Line Infections) Continued...
Preventing Central Line Infections: How Family and Friends Can Help What Hospitals Are Doing In the hospital: Owensboro Health has a plan to reduce line • Wash your hands well before and after visiting infections. The plan includes these five steps: the patient Handwashing: Hospital staff wash their hands • Be sure doctors and nurses wash their hands before and after before and after touching the line. They use soap checking the patient’s line. They should use soap and water or an and water or an alcohol-based hand cleaner alcohol-based hand cleaner. Don’t be afraid to speak up if you containing at least 60 percent alcohol. don’t see proper handwashing. • Try not to touch the line or dressing Sterile clothing and drapes: The healthcare worker who places the line wears sterile clothing. At home: This includes a long-sleeved gown, mask, gloves, • Learn sterile dressing technique if you will be caring for the and hair covering. The patient is fully covered line at home. The doctor or nurse can show you how. with a sterile drape (a large, sterile sheet) except for the spot where the line is placed. Tips for Good Handwashing • Use warm water and plenty of soap. Work up a good lather. Sterile skin: Before the line is placed, the patient’s • Clean the whole hand, under your nails, between your fingers, skin is cleaned with an antiseptic solution. and up the wrists • Wash for at least 15 seconds. Don’t just wipe. Scrub well. Vein choice:Whenever possible, the line is placed • Rinse, letting the water run down your fingers, not up your in a vein that has a lower risk of infection. Some wrists. hospitals use lines coated with an antiseptic to • Dry your hands well. Use a paper towel to turn off the faucet reduce the chance of infection. The site where and open the door. the line enters the body is covered with a sterile dressing. Using Alcohol-Based Hand Gels Alcohol-based hand gels are also a good choice for Checking for infection: The line is checked every cleaning your hands. Use them when you don’t day for infection. It is removed as soon as it is no have access to soap and water or your hands aren’t longer needed. visibly dirty. Follow these steps: • Spread about a tablespoon of gel in the palm of one hand. Preventing Central Line Infections: • Rub your hands together briskly, cleaning the backs of your What Patients Can Do hands, the palms, between your fingers, and up the wrists • Ask lots of questions. Find out why you need the • Rub until the gel is gone and your hands are completely dry line and where it will be placed. Learn what steps When to Call the Doctor the hospital is taking to reduce the danger of Call the doctor right away if you have a central infection. line and develop any of the following: • Wash your own hands often. Use soap and water • Redness, swelling, warmth, or pain at the catheter site or an alcohol-based hand gel containing at least • Drainage, pus, or bleeding from the catheter site 60 percent alcohol. • Swelling under the skin at the catheter site • Be sure doctors and nurses clean their hands • Fever of 100.4°F or higher, or shaking chills with soap and water or an alcohol-based hand • Shortness of breath or chest pain cleaner before and after checking your line. Don’t be afraid to remind them. If you have any questions regarding your line, please • Try not to touch your line or dressing notify your nurse and ask them to notify the IV Team. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 29
Post-Operative Information (Continued)
Why is your blood sugar level so Tight Blood Sugar important? • If you do have a high blood sugar level, it does not mean Latest studies show how controlling your blood sugar can you have diabetes. This is usually temporary in a hospital play an important role in helping you recover. setting. Usually after a patient recovers, a non-diabetic patient returns to normal levels. • Your blood sugar will be tested to determine if you have a high blood sugar level called hyperglycemia. Your • Your blood sugar levels will have to be tested for as long as healthcare team may give you medication to help lower they are elevated and also depends on how quickly you your blood sugar level to help your body fight infection recover. and recover faster. • It is also important that blood sugar does not fall too low. It • Quite often patients have elevated blood sugar levels is important to have the right combination of medication while they are in the hospital. This is one of the normal and food to keep your blood sugar level in control. ways your body responds to severe illness, injury, medication, stress, and surgery. • While it might seem confusing, it can be an important part of helping you get better. • It is very important to control your blood sugar level. Studies show that certain patients in intensive care with • If you have additional questions, please talk with your good blood sugar levels did not develop the doctor or your hospital healthcare team. complications other patients did. This could mean fewer infections and going home sooner.
• In order to control your blood sugar level, your healthcare team may need to test it regularly – sometimes every hour. Only a small drop of blood is needed for this testing. • Sometimes your body needs help and you may receive medication called insulin to help keep your blood sugar level in control. Insulin can be given to you by a shot or added to your intravenous (IV) drip. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 30
Post-Operative Information (Continued)
Visiting Incision Care It is very important to limit visitors early in your Good hygiene is of utmost importance in the care of your recovery process in order for your nurse to provide the incision lines. There will be a dressing on your chest care you will need. In the early stages of your recovery, incision that will come off after you leave the hospital by visiting will be restricted to short visits by immediate the home health nurse. The ace wraps on your legs will family only. be removed on the second day after surgery.
As you progress, visiting restrictions will be relaxed After the chest tubes have been out for 24 hours, you somewhat, and family visiting will be increased. The may shower using an antibacterial soap. Use a separate nursing staff will provide you with a guide to identify wash cloth for your body, chest and leg incisions. Clean specific visiting times, and each room on the the incision lines from top to bottom. Continue to use progressive care unit will have telephone access, so you antibacterial soap and separate wash cloths for 2 can "visit" by phone as you feel like it. weeks after you go home. The silver dressing over the wounds that you will go home with are ok to get wet in Your doctors and the nursing staff will also provide you the shower. Once they are removed the wound is ok to and your family with periodic updates on your get wet in the shower as well. You should not soak the progress and will also be happy to update you upon wounds in a bath tub, hot tub, swimming pool, or request. Jacuzzi under water for the first month, or until well healed. Pat the incision line dry with a clean towel once If you or your family need to request special visiting out of the shower. DO NOT put any creams, lotions, or accommodations, please notify the nursing staff or unit powders on the incision lines. If you have leg incisions, be secretary. sure that the groin area is dried completely after washing. Diet The Day After Surgery to Discharge Your doctor will order the type of diet best suited for • The morning after surgery much of the special your recovery. The nursing staff and/or the dietitian equipment used for your immediate recovery will have will explain any dietary restrictions. Please do not eat been removed. anything brought from outside the hospital without first checking with the nursing staff. • You should expect to be out of bed the evening of your surgery or the morning after, depending on your progress and the time your surgery was completed.
• As you progress toward leaving the hospital, the doctors, nurses, educators and staff from the Progressive Care Unit will prepare you and your family for your care at home.
• You may note some changes in your medications after surgery. These changes will be reviewed with you in detail before you leave the hospital. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 31
Discharge Information - "Do’s And Dont's"
Time After Discharge Permitted Activities Activities to Avoid "Do’s" "Dont's"
Weeks One and Two • Personal hygiene (bathing, • Straining or lifting more than 5- dressing and shaving) 10 pounds • Basic food preparation • Walking steep grades or hills • Desk work (reading, typing, • Activities performed in extreme writing) temperatures • Riding in a car • Sweeping, shoveling, digging, • Board or card games cutting grass or hedges, golfing, • Craft work (sewing, knitting, hunting, fishing etc.) • Competitive activities • Level walking • Walking medium to large dog • Attending church • Carpentry or painting • Shampooing hair • Driving • Walking
Weeks Three and Four • All activities of week 1 & 2 • Straining or lifting activities • Light housework (dusting, requiring more than 10-15 dishwashing) pounds • Grocery shopping and errands • Walking steep grades or hills • Restaurants • Activities performed in extreme • Walking slight grades temperatures • Slow-paced dancing • Sweeping, shoveling, digging, • Pumping gas cutting grass or hedges • Light garden work (weeding, • Competitive activities planting small plants, no • Walking medium to large dog digging) • Carpentry or painting • Golf (putting only) • Driving
If your surgery was • Return to work • Straining chest muscles completed using the • Resume household chores daVinci robot • Resume Driving
Weeks Five and Six • All activities of weeks 3 & 4 • Straining or lifting activities • Medium housework (sweeping, requiring more than 20 pounds laundry, windows) • Walking steep hills • Light carpentry and painting • Activities performed in extreme (no ceiling or high ladder work) temperatures • Light auto maintenance • Sweeping, shoveling, digging, • Golf (pitch and putt, no driving) cutting grass or hedges • Catch and toss baseball, softball • Driving will be discussed by your (no football, basketball or physician (usually permitted bowling) around six weeks after surgery) • Garden work (no digging) • Walking dog Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 32
Discharge Information - "Do’s And Dont's"
Time After Discharge Permitted Activities "Do’s"
After Six Weeks • Continue activities of weeks 1-6 (but you may be able to tolerate more) • Return to work part-time (if your job does not require lifting and returning is approved by your surgeon) • Heavy Housework: Vacuuming, Sweeping or Laundry • Heavy Gardening: Mowing lawn or raking leaves • Ironing • Business or recreational travel • Fishing • Light aerobics (no weights) • Walking dog on leash • Driving a car or small truck • Boating
After Three Months • Continue activities of weeks 1 to 3 months (but you may be able to tolerate more) • Heavy housework scrubbing floors • Heavy gardening: shoveling snow, digging • Football/Soccer • Softball/Baseball • Tennis • Bowling • Hunting • Jogging • Bicycling • Golfing • Weight Lifting • Motorcycle riding • Push-ups • Swimming • Water skiing Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:55 PM Page 33
Discharge Information Following Your Heart Surgery
After A Surgical Procedure, It’s Perfectly Normal To...
• Not have much appetite. It takes several weeks for your appetite to return. Many patients notice that their sense of taste is diminished or almost absent. It will return. Some patients even complain of nausea at the smell of food for a week or two after surgery. It may be best to eat small amounts of food several times a day, rather than 3 larger meals. Remember some medications are best taken with food to prevent increased nausea.
• Have some swelling, especially if you have an incision in your leg. That leg will tend to swell more for some time. Elevating your legs will help. Wear your elastic TED hose if they were prescribed for you.
• Have difficulty sleeping at night. You may find it difficult to fall asleep, or you may find that you wake up at 2:00 or 3:00am and cannot fall back to sleep. This will improve. Taking a pain pill before bed sometimes helps. Other ways to improve sleep at night is to gradually increase activity during the day and limit the number and length of naps.
• Have problems with constipation. Anesthesia and pain medications can slow down bowel activity. Therefore, you should continue using a stool softener as long as you are taking pain medications. You may also use a laxative of your choice if you experience constipation. Adding more fruits, fiber and juices to your diet may also help. These tips along with increased activity should help bowel activity return to normal.
• Have mood swings or feel depressed. Feeling depressed, anxious or worried are very common emotions after a surgical procedure. These feelings usually only last a couple of weeks and generally improve without medications or treatments. You may have good days and bad days. Do not become discouraged. This will get better. There is more about handling stress and mood swings later in this section.
If Your Chest Was Opened For Surgery, It’s Perfectly Normal To... • Have a lump at the top of your incision. This will disappear with time. • Notice an occasional “clicking noise” or sensation in your chest in the first days after surgery. This should occur less often with time and go away completely within the first couple of weeks. If it gets worse, call your surgeon. • Experience muscle pain or tightness in your shoulders and upper back between your shoulder blades. This will get better with time. Your pain medicine will also help relieve this discomfort.
• Experience numbness to the left of your incision. This is normal, if an artery in your chest, called the mammary artery, was used during your surgery. Remember it takes 4 to 6 weeks to start feeling better. Remember! Your sternum (breastbone) will take approximately 6 weeks to heal. (About the same length of time it takes to heal a broken leg.) This bone is held together by wires that will remain forever. It is important that you do not lift or pull anything that could cause this to shift. The sternum may have a slight click, pop or grind as it is healing. Notify your surgeon if you notice any unequal movement of your breastbone. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 34
Discharge Information Following Heart Surgery
Activities to Promote A Speedy Recovery
1. Balance rest with activity or exercise. Slowly do a 4. DO NOT LIFT MORE THAN 10 POUNDS FOR little more each day. Rest when you are tired. Set 6 WEEKS. A gallon of milk weighs approximately 8 goals that you can reach. Recovery from heart lbs. so let this be your reference. Do not push or pull surgery is generally 6 weeks. Plan two 30-minute objects heavier than 10 pounds - this includes lifting rest periods each day for the first few children, groceries or suitcases or activities such as: weeks. vacuuming, moving furniture, mowing the lawn, • Stop exercising at first sign of severe fatigue, mopping the floor, changing bed linens, digging holes, angina, or shortness of breath: If you playing golf, hunting, or fishing. The amount of weight experience any of the following, stop you are allowed to lift, push or pull will gradually exercising - chest pain, irregular heartbeats, increase. dizziness, shortness of breath or muscle strain. These should go away with rest. 5. Light work around the house not requiring straining - such as light home repairs, light household chores such 2. Exercise improves muscle tone and strength after as preparing meals and washing dishes are okay to do. surgery. It takes time to get your strength back. BE PATIENT! 6 Stairs - you can climb stairs but take your time and go • It is very important that you begin a walking slowly. Place your foot sound on each step and use the program as you recover from your surgery. hand rail. You may need to rest after every 3 to 4 steps Walking is a safe, aerobic exercise and will if it is a long flight of stairs. Sit down and rest if you help you build a heart healthy lifestyle. become short of breath.
• Walking - start walking on flat surface if 7. Outpatient cardiac rehab programs are highly possible. Slowly add to the distance over the recommended for our patients after open heart surgery. next month Consult your cardiologists or family doctor for • Walk only when you are rested. Wait at least appropriate time to start this program. two hours after a heavy meal. 8. You may experience some slight swelling in your feet • Avoid hot and cold temperature extremes and legs for a short time after surgery. This should (walking in the mall may be a good improve as you recover and become more active. To alternative to outside). help minimize these symptoms, we recommend avoiding crossing your legs and avoid sitting in one 3. You may take short rides in the car or brief outings position or standing for long periods of time. after the first week. Avoid long trips. Your reaction When sitting, raise your legs on a foot rest, stool or time will be slowed due to fatigue. Do not drive for coffee table. You can also lie on the couch and elevate four weeks (2 weeks if you had robotic surgery) or your legs on the arm of the couch. while you are taking pain medication. Try brief driving trips at first. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 35
Discharge Instructions Following Heart Surgery (Continued)
Note: Handwashing is one of the major keys in keeping incision free of infection.
9. Elastic Stocking (TED Hose) – If Prescribed: 3. If you have steri-strips on your incisions, they may If they were prescribed for you, wear your elastic be removed in two weeks if they have not fallen off stockings for at least two weeks after discharge. The with a shower. If you have staples on your incision, stockings help decrease swelling, especially if you you may need to return to your surgeon's office for have a leg incision. Remove your stockings at removal in one to 2 weeks. If skin adhesive was bedtime. Wash the stockings with mild soap and used, follow wound care instructions in this water, and dry them on a line. manual.
10.Weigh yourself daily: This should be done first 4. Your incisions may be bruised, sore or itch. In a few thing in the morning. Keep a record of your weight. weeks your scar will begin to look better. It is A weight gain of 2-3 pounds in one day is due to common to notice a lump or swelling at the top of fluid, not fat and this should be reported to your your chest incision - it will slowly go away. doctor if it occurs 2 days in a row. 5. Keep in mind that incisions may sunburn easily. Be 11.Incentive Spirometer – sure to protect your incisions from over exposure to Respiratory problems are the number one reason sunlight during the first year after surgery. The scar patients are readmitted to the hospital after heart will pigment more (be darker) if exposed to sun. surgery. To help prevent readmission it is important Do not apply any lotions, creams, oils, powders on that you continue to work to keep your lungs clear your incisions, unless prescribed by your cardiac and healthy by using your incentive spirometer and surgeon. taking deep breaths. Hold your heart pillow to your chest to splint it when coughing and 6. The left side of your chest may hurt more than the deep breathing. right side, if the artery inside your chest wall (LIMA) was used for a bypass. You may use a Incision Care heating pad or hot water bottle covered with warm moist towels for 20 minutes - 4 times a day for 1. Inspect incisions daily for redness, incisional or back and shoulder discomfort. swelling or drainage. Any change in appearance 7. You may shower every day to help heal incisions. or drainage Use a mild soap and warm water (not hot) to should be reported to the surgeon. bathe. DO NOT use lotion or powder on the incision line after your bath until the skin has 2. If TheraBond Silver Dressing healed completely. was used over your incision, leave the dressing on for at least 8 .Do not use a hot tub or Jacuzzi or soak in a bath 7 days. Your home health nurse tub until OK’d by your surgeon. will remove it during a home visit. You may shower with this 9. Numbness along the incision line is normal and dressing in place. may last from 6 weeks to 1 year or longer. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 36
Discharge Instructions Following Heart Surgery (Continued)
Diet Sexuality Your appetite will slowly return to normal the first You may be worried about whether you can return to your month. Sometimes smaller, lighter meals are more normal sex life. Most cardiac patients can, and here are some appealing. Eat whatever sounds good to you - except things that you should know about the effect having sex has foods high in salt (salt makes you retain water) - for the on your heart. first month. We are concerned with the return of your strength and your incisions healing well. Introduce Several things that can cause problems with having sex: changes into your diet gradually. • Fear and anxiety – you may be afraid that it will stress A heart healthy diet is one that is low in saturated fat, your heart cholesterol, sugar, sodium and caffeine. Most people • Depression – it is common to have some depression find they can keep eating what they like, once they after a heart attack or surgery learn to prepare foods in more healthy ways. • Heart medicines – some medicines can affect your desire for sex or your performance Check with your physician before drinking any alcoholic beverages. Since having sex is a form of exercise, it is normal for your The dietitian will be going over information regarding heart to beat faster and for you to breathe harder as you your diet prior to discharge. Please refer to the Heart engage in sex and move your body. Soon afterwards, your Healthy Eating section of this manual. heart rate and breathing should slow down and return to near normal levels. Emotions Feelings of depression, anxiety, or worry are very The heart works hardest during the short time (10-15 common. When your physical strength improves, your seconds) it takes to reach climax. The same amount of work emotional outlook will improve as well. You may be – or even more – is needed by the heart during other tearful, irritable or have bad dreams. activities, such as climbing stairs or walking briskly around the block. Medications Upon your discharge, your doctor will write Please follow these precautions: prescriptions for medications he wants you to be on at • Avoid having sex after having a large meal or home. Take only the medications prescribed for you at drinking alcohol the time of discharge. Do not increase, decrease, or stop • Avoid sex when you feel nervous, angry or rushed, your medications without your doctor's approval. since this stress will add to the demands placed on Know what each medication is for and the side-effects. your heart. • Avoid having sex in a hot, humid or a very cold A pain pill will be among these for your use as needed room, because your body and heart will need to to keep you comfortable as you recover. You may rest work harder better if you take them before going to bed. • Avoid sex if you are tired Medications taken before surgery should not be continued unless your doctor says it is fine. Refer to the • Avoid positions that cause fatigue medication list sent home with you as to the medication you will be taking at home. This manual It can take 4-6 weeks to return to your normal routines, so provides general information on the most commonly allow yourself time to become intimate again and enjoy prescribed medications. having sex. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 37
Discharge Instructions Following Heart Surgery (Continued)
Getting Back To Normal: Risk Factors
Recreation There are certain factors that are known to cause blockages in your arteries. It is recommended to avoid Once you begin to feel better, you may enjoy dining these in the future. out, going to movies, getting your hair styled or short shopping trips. Pay attention to how you feel. You will • Smoking be the best judge of when it is time to rest. • Diet high in saturated fat • High blood pressure - It is important to keep blood Smoking pressure under control. • Obesity Since this surgery may have forced you to stop • Stress smoking, it is important that you continue to NOT • Lack of exercise SMOKE. Smoking can increase heart rate, narrow blood vessels, increase blood pressure, cause spasms of People with a family history of diabetes are at a greater the coronary arteries, and damage the lungs. Smoking risk of heart disease. is the worst thing you can do to your heart. Please see the section "About Smoking" in this manual.
Returning to Work
Your return to work should be gradual. Generally wait 8-12 weeks before returning and your doctors must be consulted about this. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 38
Managing Stress
What is stress and how can it affect you? Stress is what you feel when demands, either mental or physical, are placed on you. These demands are called stressors.
You are probably faced with stressors each day. When you are stressed, many changes take place in your body as a part of the normal response. Some changes you may be aware of are muscle tension, fast heart rate, sweating, or a "gripping" in your stomach. You become more alert and ready to face the stressor. Once the event is passed, your body relaxes and returns to normal.
Some stress can be good, however extreme or long-term stress can affect your health. When you are over- stressed, your body cannot relax. This can lead to physical problems like ulcers and migraine or tension headaches. Stress alone does not cause heart attacks, but it can help lead to high blood pressure, high blood cholesterol and irregular heart beats. The following information can help you name some of your own stressors. It will offer you some tips for making stress work for you instead of against you.
Are you stressed by change? What are some of the stress signals that let you know you are under Change is a fact of life. Some stressful events in your stress? life can leave you feeling helpless, angry, guilty, or depressed about the loss of things that are familiar to • Muscle tension you. Change can also be very positive. Change • Short temper, nagging becomes a problem only when you can’t relax and • Constipation or diarrhea recover from it. The things listed below may be sources • Jaw clenching of stress for you. The question to ask yourself is: "Am I • Increased sweating stressed by these changes?" Knowing what causes you • Crying stress is the first step in learning to manage it. • Nausea, stomach pains • Change in health • Avoiding friends • Change in lifestyle or habits (stopping smoking, • Headaches new eating patterns) • Sadness or feeling hopeless • Change in life events (divorce, marriage, • Pacing, sleeping problems retirement, becoming a parent or grandparent) • Feeling depressed • Change in finances • Feeling restless • Major change in a family member’s life (marriage, • Increased eating, drinking or smoking aging, death) • Unable to concentrate • Change in where you live • Worry, anxiety, nervousness • Change in job demands • Changing jobs. • Fears about job security Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 39
How To Care For Your Wound
How to care for your wound The following will answer some of your questions and provide instructions for proper care for your wound while it is healing.
Check Wound Appearance Topical Medications • Some swelling, redness and pain is common with all • Do not apply ointment medications or any other wounds and normally will go away as the wound product to your wound while the adhesive strips are in heals. If swelling, redness, or pain increases or if the place. This may loosen the tapes before your wound is wound feels warm to touch, contact a doctor. If the healed. Ask your surgeon before applying ointments to wound edges reopen or separate, contact a doctor. the wound.
Keep Wound Clean & Dry Bandaging • Protect your wound from repeat injury until the skin • If the wound is clean and dry, leave it open to air. has had sufficient time to heal.
• If bandage is needed once the silver dressing is • You may occasionally and briefly wet your wound in the removed, keep the bandage dry. shower. Do not soak or scrub your wound, do not swim, and avoid periods of heavy perspiration until the • Replace the dressing daily until the wound is free of wound is well healed. After showering, gently blot your drainage. If the dressing should become wet, change wound dry with a soft towel. If a protective dressing is it as needed to keep it clean and dry. being used, apply a fresh, dry bandage, keeping tape off the wound. • Do not scratch, rub, or pick at the adhesive tapes. This may loosen the tapes before your wound is • Apply a clean, dry bandage over the wound if necessary healed. to protect the wound.
• Do not place tape directly over the adhesive strips If you have any questions or concerns, please consult your because removing the tape may also remove the steri doctor. strips.
• Protect the wound from prolonged exposure to sunlight or tanning lamps while it is healing. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 40
Quick Tips
Call the Physician if:
• Your heart rate or pulse is too high (above 120) or too low (below 60)
• You detect an irregular heart beat, your pulse is irregular or you feel a fluttering feeling in your chest
• Your temperature is elevated (greater than 100.5 degrees F)
• You have increases swelling, redness or drainage along any of your incision lines
• You have discolored drainage or foul smelling drainage from any of your incision lines
• You experience new or increased shortness of breath
• You have a weight gain of 3 pounds or more in one day for 2 consecutive day
• You experience dizziness, fainting, cool/clammy skin
• You have a color or change in your urine or bowel movements. Dark bowel movements are expected if you are taking an iron supplement.
• You develop severe calf or leg pain
• You develop unusual rashes
• You develop ongoing nausea or vomiting
• If you experience unrelieved chest pain, call for help and go immediately to the closest hospital emergency department
Emergency Preparedness When you have been diagnosed with a heart problem, • Know the shortest route to the hospital. it is very important to have a plan in case of emergency. Below are some tips to help you be • Always carry nitroglycerine (if it has been prepared. prescribed for you) in the original bottle it came • Keep a current list of your medications with in from the pharmacy. Nitroglycerine must be you (in your wallet or purse) at all times fresh to be effective and should be replaced every including the name of the medication, the six months. dose and the times taken. • Your family and friends should be trained in • Keep copies of physician telephone numbers Cardiopulmonary Resuscitation (CPR), available with you and near the telephone. You may through the American Red Cross. Please call wish to give a copy to family members as well. (270) 688-4811 for more information.
• If your area is not served by 911, keep emergency numbers beside your telephone. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 41
Counting Your Pulse
Count your pulse to find out how fast or slow your heart is beating or to feel any extra or irregular beats. • At rest or as soon as you stop exercising, find your pulse at a wrist or neck. • Look at a clock or watch with a second hand, and count how many beats you feel in 10 seconds. • Multiply that number of beats by 6. This is your heart rate for that time.
You can also use this chart to figure your heart rate after counting your pulse for 10 seconds:
Heart Rate Chart 10 Secs 1 Min 10 Secs 1 Min 10 secs 1 Min
8 48 15 90 22 132 9 54 16 96 23 138 10 60 17 102 24 144 11 66 18 108 25 150 12 72 19 114 26 156 13 78 20 120 27 162 14 84 21 126 28 168
The staff will talk with you about what your heart rate should be while exercising. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 43
Heart Healthy Eating
There are a number of heart risk factors that can be controlled with a healthy diet. These include: high blood cholesterol levels, high blood pressure, and being overweight. By adopting an eating pattern that limits cholesterol, saturated fat and salt, is high in fruits, vegetables and fiber, and meets your need for protein, vitamins and minerals, you have taken a major step toward leading a heart healthy lifestyle.
Although learning to live with a heart healthy diet takes some time, the benefits last a lifetime. It will be easier for you to change your eating patterns gradually, rather than all at once. It is never too late to start, but the earlier in life you begin a heart healthy diet, the more likely you are to benefit from it.
Definition of Fat HDL Cholesterol (high density lipoprotein) is often Total Blood Cholesterol is one of the markers in called "good" cholesterol. It removes cholesterol from the evaluating your risk for heart disease. Too much arteries and carries it back to the liver where it is disposed, cholesterol in the blood increases the risk for thus helping decrease the risk of heart and vessel disease. developing heart and blood vessel disease. Cholesterol It's good to have more of this type of cholesterol in your is a soft, waxy substance that is made by your liver. blood. A desirable HDL cholesterol level is greater than Cholesterol is also found in animal products we eat. 60 mg/dl. The cholesterol and saturated fats you eat can raise Triglycerides are fats that are carried through the your blood cholesterol level. A desirable cholesterol bloodstream. They are made by your body and also level is less than 200 mg/dl. found in food you eat. High levels of triglycerides are Cholesterol cannot dissolve in the blood stream, so it associated with abnormal levels of cholesterol, LDL and combines with protein to form a special carrier (small HDL. Factors which may lead to a high triglyceride level fat globule) called a lipoprotein. Lipoproteins travel include a diet high in excess calories from fats and/or through the bloodstream carrying cholesterol to sugars and starches, heavy drinking, excess body weight, various parts of the body, where cholesterol helps to and uncontrolled diabetes. A desirable triglyceride level is carry out essential body functions. less than 200 mg/dl.
There are two main types of lipoproteins – HDL (high What is a heart healthy diet? density lipoprotein) and LDL (low density lipoprotein) A heart healthy diet is a wholesome eating pattern that – and which lipoproteins you have more of is meets the body's needs while lowering the intake of salt, important. High levels of LDL increase heart disease sugar, saturated fat and cholesterol. Eating a heart healthy risk, while high levels of HDL help protect against diet does not mean avoiding those foods and traditions heart disease. that have a special meaning for you. It does mean learning to make healthy choices in the foods you eat. LDL Cholesterol (low density lipoprotein) is often Guidelines for a heart healthy diet include: called "bad" cholesterol. When you have too much LDL cholesterol in your blood, it can join with cells • Avoiding too much saturated fat and cholesterol; and fat and build up on the inner walls of arteries. This substituting them with unsaturated fats can cause a blood clot, block blood flow and cause a • Avoiding too much salt heart attack or stroke. A desirable LDL cholesterol level • Maintaining a desirable weight is less than 130 mg/dl. • Eating a variety of foods • Eating foods high in fiber • Avoiding alcoholic beverages or drinking them only in moderation Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 44
Heart Healthy Eating (Continued)
What is cholesterol? What are Polyunsaturated Fats? Dietary cholesterol is a waxy material that comes from Polyunsaturated fats come from vegetable sources and are animal sources such as egg yolks, meat (especially liquid at room temperature. Polyunsaturated fats are organ meats such as liver), poultry, fish and high fat found in corn, safflower, soybean and sunflower oils. dairy products (such as butter, cream, whole milk and most cheeses.) Polyunsaturated fats (when it replaces saturated fat in the diet) have been found to lower blood cholesterol and What are fats? LDL cholesterol levels. Some dietary fats are needed for good health. Fats The fats in most fish contain a certain type of supply energy, essential fatty acids, and promote polyunsaturated fat (Omega-3 fatty acid) which is being absorption of the fat-soluble vitamins A, D, E, and K. studied because of a possible association with decreased Fat, whether from plant or animal sources, contains risk for heart disease. more than twice the number of calories of an equal amount of carbohydrate or protein. Fats exist in two What are Monounsaturated Fats? forms: saturated and unsaturated (monounsaturated Monounsaturated fats (the healthiest kind of fats) come and polyunsaturated) fatty acids. from vegetable sources and are liquid at room temperature. Monounsaturated fats are found in olive, What are saturated fats? canola, grape seed and peanut oil. According to recent Saturated fats tend to raise blood cholesterol and LDL research, monounsaturated fats help lower blood cholesterol levels more than unsaturated fats. They are cholesterol and LDL cholesterol levels as well as maintain usually solid at room temperature. The fats of animal HDL (the good) cholesterol levels. origin are the main source of saturated fats. The plant sources that have a large amount of saturated fat are tropical oils (coconut, palm kernel and palm oil), and chocolate. Most non-dairy creamers and nondairy whipped toppings are made from tropical oil.
What Are Trans Fatty Acids? On a food label it is listed as "hydrogenated oil" or "partially hydrogenated oil". Trans fatty acids are formed when manufactures harden oils to more solid forms to increase the shelf life of their products.
Food manufacturers harden oils in their products to keep the foods from going rancid on shelves and to give them a desired texture. These fats are found in stick margarines, vegetable shortenings, packaged snacks and baked goods. Trans fatty acids have been found to raise blood cholesterol and LDL cholesterol levels as much as saturated fats do. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 45
Heart Healthy Eating (Continued)
Choosing Your Food Learning what foods to choose and how to prepare them is an important part of adopting a heart healthy diet. The following guidelines can help you to make better choices. • Choose to have foods broiled, baked, steamed • Choose fresh foods (fresh meat, poultry, fish, fruits and or poached rather than fried. vegetables) for cooking. • Choose fresh fruit with skin rather than sweets • Choose monounsaturated oils for cooking for dessert or snacks. • Choose margarines that are in a tub or liquid form. Avoid • Avoid convenience foods: they are generally stick margarine. high in trans fat and salt. • Choose herbs or lemon for seasonings instead of salt.
How Do I Get Started? When making a change in your eating habits, it is important that you set reasonable goals for yourself. Habits take time to develop. A lifetime habit of unhealthy eating cannot be changed overnight. Select a few of these ideas to start and build on them until you reach your heart healthy eating goals. Changing your diet is difficult, and you can expect some slip-ups along the way. Do not get discouraged. You will succeed as long as you get back on track at the next meal. A registered dietitian or your doctor can help you set up a diet plan. THE ROLE OF FIBER IN A LOW FAT DIET
What exactly is "Fiber"? How much fiber do I need a day? The recommendations for healthy adults are 25-38 grams Fiber is the indigestible part of plant foods, often called of fiber per day. A variety of high fiber foods will ensure "roughage" or "bulk." There are two types of fiber that that you receive the benefits of both soluble and insoluble play an important role in a healthy diet. fiber.
• Insoluble Fiber: This type of fiber doesn't dissolve What are the benefits of a high fiber in water, but can hold large amounts of water in diet? the intestines. This increases the volume of the stool • Help lower cholesterol and enables it to pass through the intestines more • Help give the feeling of "fullness" quickly, preventing constipation. Cellulose is a • Help control blood sugar major form of insoluble fiber. It gives structure to • Prevent constipation plants and is found in all kinds of plant material. • Reduce risk of colon cancer Humans cannot digest cellulose because it cannot • Help in the treatment of hemorrhoids, irritable bowel be broken into units small enough for absorption. syndrome and diverticulosis The major source of cellulose is in the protective outer layers of whole grains called bran. Other good Guidelines for increasing your fiber sources of insoluble fiber are whole wheat products, intake fruits with skins and fruits with edible seeds. • Increase fiber intake gradually to prevent diarrhea • Eat a variety of fiber-rich foods in reasonable amounts • Soluble Fiber: This type of fiber does dissolve in • Drink 8 glasses of water every day to help move the water. Some studies have shown that increased fiber along the intestinal passage. amounts of soluble fiber in the diet may help to • Eat "raw" fruits, especially those with skin, seeds, and lower blood cholesterol as well as help the membranes (such as an orange) body to regulate blood sugar levels. Some good sources of soluble fiber are apples, oranges, carrots, oat bran, barley and dried beans. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 46
Heart Healthy Eating (Continued)
American Heart Association – Cardiac Diet
Indications For Use (Rationale) Comments This diet is designed for individuals who are either The diet is designed to provide: at risk for or who have experienced heart disease. • 20-35% of total calories from unsaturated fats The diet can also be used by individuals who must • No more than 7% of total calories from also restrict not only their fat intake but also their saturated fat intake of sugar and/or salt. • Less than 3000 milligrams of sodium (3 grams) • Increased fiber intake • Decreased caffeine intake
FOOD GROUP FOODS ALLOWED FOODS TO AVOID
Meat, Poultry, and Chicken and turkey - cut off the "Prime" grade and other heavily Seafood skin; this is where much of the fat is marbled and fatty meats, such as found. corned beef, regular pastrami, short ribs, spare ribs, rib eye roast and Limit intake to Lean beef, veal, pork, and lamb - steak, regular ground meat, hot dogs, 6 ounces per day trim all visible fat. Use extra lean sausage, bacon, high fat luncheon ground beef, sirloin tip, round steak, meats, such as bologna and salami; 3 oz. resembles the size of a rump roast or tenderloin chicken or turkey with the skin; deck of cards domestic goose or duck; organ Fish and shellfish - limit the use of meats, such as liver, sweetbreads, shrimp and lobster; choose low kidneys, and brains, sardines and sodium canned tuna or salmon roe; ham, regular canned fish and meat, frozen T.V. dinners, pot pies, Wild game - rabbit, pheasant, convenience entrees, meat gravies, venison, wild duck, and other wild meat sauces. game animals generally have less fat than animals raised for the market. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 47
Heart Healthy Eating (Continued)
3 Gram Sodium Diet (Continued)
FOOD GROUP FOODS ALLOWED FOODS TO AVOID
Eggs Whole eggs or egg yolks More than four egg egg whites (2 whites = 1 whole egg in yolks per week. Limit to 3-4 egg yolks per recipes), cholesterol-free egg week substitutes. Milk and milk products Dairy Products Milk products containing only containing more than 1% milk fat 0-1%milk fat - skim milk, 1/2- 1% - whole milk, 2% milk, dried whole 2 or more milk, nonfat drymilk, evaporated milk, buttermilk or yogurt made servings per day skim milk, buttermilk made from from whole milk, drinks from whole skim milk, fat-free sour cream, fat- milk, condensed milk, evaporated free cottage cheese. whole milk, ice cream
Low-fat cheese - made from skim or Cream, all kinds - Half and half, 2% milk, or natural cheese with no light, heavy whipping or sour cream more than 5 grams of fat per ounce. Nondairy cream substitutes coffee creamers, whipped topping, and palm oil, which are high in saturated fat. Use fat-free creamers and whipped toppings.
All cheese containing more than 5 grams of fat per ounce - cream cheese, creamed cottage cheese, and most other natural an processed cheeses, such as American, Swiss, mozzarella, and bleu. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 48
Heart Healthy Eating (Continued)
3 Gram Sodium Diet (Continued)
FOOD GROUP FOODS ALLOWED FOODS TO AVOID
Fruits and Vegetables Fresh, frozen, low sodium canned Vegetables prepared in butter, cream fruits and vegetables, low sodium or other sauces, vegetable juices to 5 or more servings per day vegetable juices which salt has been added, brine- cured vegetables, sauerkraut, pickles or olives Fats and oils Unsaturated vegetable oils safflower, sunflower, corn, soybean, cottonseed, Saturated fats - butter, lard, bacon Limit to 5-8 teaspoons per canola oil, sesame, olive and peanut drippings, coconut oil, palm oil, day palm kernel oil, hamhocks, salt pork, Margarines - spray, tub, squeeze, or meat fat and drippings, gravy from diet. One of the above unsaturated meat drippings, shortening, suet. oils should be listed as the first Margarines in stick form. ingredient.
Salad dressings and mayonnaise low calorie low sodium dressings Dressings made with egg yolks, Baking cocoa excessive amounts of high sodium dressings. Seeds and nuts - all seeds (pumpkin, sesame, sunflower), and most nuts; Chocolate unsalted peanuts, natural peanut butter. Coconut, regular peanut butter, salted nuts and seeds. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 49
Heart Healthy Eating (Continued)
3 Gram Sodium Diet (Continued)
FOOD GROUP FOODS ALLOWED FOODS TO AVOID
Breads Homemade baked goods using Commercial baked goods - pies, and cereals unsaturated oils and skim milk cakes, doughnuts, croissants, pastries, biscuits, muffins, cornbread, soft rolls, muffins, biscuits, high fat crackers 6-11 servings per day pancakes, French toast, and waffles. and cookies. Use your weekly egg yolk allowance *Choose sources with 3 or (4 per week), and whole wheat flour Salted pretzels, potato chips, corn more grams of fiber per if possible. chips, saltines, microwave popcorn. serving Low-fat crackers and snacks: Egg noodles animal, graham, rye, unsalted crackers, oyster, and matzo crackers; Breads in which eggs are major store bought fig bars, gingersnaps, ingredients; granola-type cereals or and molasses cookies, melba toast, any that contain 0g fiber. rusk and flat bread; unsalted pretzels, air popped popcorn and angel food cake in moderation (high in sugar).
Brown rice, whole-wheat pasta.
Whole-grain breads and cereals: oatmeal, whole wheat, rye, bran, multigrain, flax seeds, wheat germ.
Low-fat rolls - English muffins, hotdog and hamburger buns, water (not egg) bagels, pita bread, tortilla (not fried) Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 50
Heart Healthy Eating (Continued)
3 Gram Sodium Diet (Continued)
FOOD GROUP FOODS ALLOWED FOODS TO AVOID
Low Fat Soups Homemade soup made with low Soups high in sodium, fat, cream, sodium broth, low sodium tomato whole milk, or cheese, canned soups, based seafood chowders, minestrone, dehydrated soups, bouillon cubes onion, split pea, vegetarian vegetable, low sodium canned soups.
Miscellaneous Spices, condiments, herbs and spices Chili sauce, Ketchup, Worcestershire to which salt has not been added, sauce, BBQ sauce, mustard, soy vinegar, onion powder, garlic powder, sauce. decaffeinated coffee and tea. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 51
Heart Healthy Eating (Continued)
Heart Healthy Menu
MORNING NOON EVENING • Whole Orange • Homemade Vegetable Soup/Whole • Pork Tenderloin - 4 oz. • Bran Flakes • Wheat Crackers • Baked Potato with skin and fat- • Egg (limit to 4 yolks/week) • Sliced Turkey Breast (2 oz.) free sour cream or melted low-fat • Whole Wheat Toast Sandwich with Lettuce/Tomato cheese • Tub Margarine – 2 tsp. • Low Fat Salad Dressing • Broccoli steamed with lemon juice • Sugar-free Jelly • Fresh Pear with skin • Tub Margarine - 2 tsp. • Skim Milk • Decaffeinated Tea/Lemon • Tossed Salad • Decaffeinated Coffee with • Vinegar and Olive Oil Dressing calorie free sweetener • Skim Milk SNACK SNACK • Air popped popcorn with spray • Lowfat yogurt sweetened margarine with calorie free sweetener • Grapes-1/2 cup and fresh fruit • Handful of unsalted almonds Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 53
Safe Medication Use
It’s important to take your medications as prescribed to optimize your recovery from your open heart surgery. This section describes the features and benefits of some of the most common medications that you may be asked to take after your surgery.
• Keep medication in the original container labeled, • For most medical conditions, your medication is a in which it was dispensed with lid sealed. Do not treatment, but not a cure for your condition. If you alter safety caps to "non-safety caps" on your own. feel well, it is because the medication is working, not If you require a non-safety cap, please request a cap because you are cured. Do not change your dose or that is designed specifically for this purpose. stop your medication without talking to your doctor. • Unless otherwise directed, medications should be stored at room temperature, away from excessive • Whenever possible, try and get all of your moisture. (for example, NOT in the bathroom or prescriptions filled at a single pharmacy. If you get over the stove) medications filled at several pharmacies, or if your physician gives you "samples" of a new medication, it • NEVER share medications is important to tell your pharmacist(s) the names and dose of all your medications so they have a complete • Consult your doctor of pharmacist before starting medication profile and can screen for drugs that do ANY new over-the-counter medication, including not work well together. vitamins or herbs. • Keep a complete list of all your medications, including • Do not use medication past the expiration date that the medication's name, strength and number of times is on the prescription label. a day that you take the medications with you at all times in the event that you require emergency care. • Try to take your medications at the same time each day. • Wear a medical alert bracelet or carry a wallet card that identifies any medication allergies you have. You • If you forget to take your medication and should also wear a bracelet or carry a wallet card if you remember before one-half of the time until your are on certain medications such as blood thinners. Ask next dose, take your medication. If it is MORE your doctor or pharmacist. than one-half of the time to your next dose, then skip that dose, and take your regular dose at the next scheduled time. Do not "double-dose" without consulting with your doctor or pharmacist. For example, if you take your medication twice a day, and remember a missed dose within 6 hours, then take the dose. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 54
ACE (Angiotensin Converting Enzyme) Inhibitors/Blockers
Uses ACE inhibitors are used primarily to treat cardiac conditions such as high blood pressure and congestive heart failure. They are also used to treat and prevent complications of other diseases such as diabetes. They work by blocking certain chemicals in your body that cause your arteries to constrict and increase our blood pressure.
How Should You Take This Dietary Considerations Medication? Considerations Capoten (captopril) should be taken on ACE inhibitors are given once to several times a day. It an empty stomach, either 1 hour before you eat or 2 is important to take your medication at the same time hours after a meal. All others can be taken without regard each day. to meals.
Common Side Effects Additional Information • Dizziness or lightheadedness In some patients, ACE inhibitors can cause retention of • Headache potassium. Consult your doctor before you start a sodium • Persistent cough restricted diet or use any salt substitutes. • Nausea and vomiting • Diarrhea
Precautions Contact your physician if you experience any of the following symptoms: • Rash • Rapid heartbeat • Sore throat • Fluid retention (swollen ankles and weight gain) • Shortness of breath or trouble breathing Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 55
Beta Blockers
Uses Beta blockers are used to treat cardiovascular conditions such as high blood pressure, congestive heart failure, irregular heart beats, and to prevent angina (chest pain). They are also given to prevent having a repeat heart attack if you have had one in the past. They work by relaxing blood vessels to reduce the "work load" of the heart.
How Should This Medication Be Dietary Considerations Used? Most beta blockers can be taken with food. It is important to take your medications at the same time each Beta blockers are given once to several times a day. Once- day in regard to meals. a-day doses are usually taken in the morning.
Common Side Effects Alcohol will increase the chance of drowsiness and dizziness and should be avoided while taking this • Drowsiness medication. • Feeling tired after physical exertion, such as walking up a flight of stairs Additional Information • Changes in bowel function, such as nausea, constipation or diarrhea Beta blockers can mask signs and symptoms of low blood sugar. Diabetics and patients with a history of low blood Precautions sugar should test their blood sugar level several times a day. Drowsiness or feeling tired may be significant when you first start taking a new medication. See how your medication affects you before driving or operating machinery.
Do not change your dose or stop taking this medication without first consulting your doctor. Contact your physician immediately if you experience any of the following symptoms:
• Difficulty breathing or shortness of breath • Fluid retentions or swelling of the hands and feet • Slow or irregular heartbeat or pulse Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:56 PM Page 56
Anti-Cholesterol Medications
Uses Anti-cholesterol medications are used along with diet and exercise to reduce your risk of cardiovascular disorders such as high blood pressure, heart attacks, stroke and angina (chestpain).
Most anti-cholesterol medications work in the liver to decrease the amount of cholesterol and triglycerides that your body makes. Bulk powders (cholestyramine, colestipol) work by binding cholesterol in your digestive system and reduce the amount that is absorbed from the foods you eat.
How Should You Take This Dietary Considerations Medication? Lopid (gemfibrozil) should be taken on an empty Tablets are usually given once or twice a day, while stomach, preferably 30 minutes before breakfast and powders are usually taken several times a day. "Statins" evening meal. are usually taken once a day in the evening. In addition to taking the medication, your doctor will Common Side Effects also recommend a diet plan that is low in cholesterol, fats and triglycerides. • Headache • Fatigue or tiredness • Dizziness or lightheadedness Additional Information Cholestyramine Binding Resin (Questran) can also bind Bulk powders frequently cause digestive side effects with other medications. It is important to take this such as gas, constipation, and bloating. medication at least 1 hour before or 4 hours after taking your other medications. Precautions Contact your physician if you experience any of the following symptoms: • Muscle pain or tenderness • Muscle cramps • Body aches or "flu-like" symptoms Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 57
Calcium Channel Blockers
Uses Calcium channel blockers are most often used to treat cardiovascular conditions such as high blood pressure, angina (chest pains), and irregular heartbeat. They work by preventing spasms of the blood vessels.
How Should This Medication Be Precautions Taken? Contact your physician if you experience any Calcium channel blockers are available as both of the following symptoms: immediate release and long acting or "extended • Swelling of the legs or extremities release" tablets and capsules. Long acting tablets and • Increase in the frequency or severity capsules are usually given once or twice a day, while of chest pain immediate acting tablets are usually given several times • Rapid heart rate or decreased heart rate a day. It is important to take your medications the same time each day to maintain a constant level of Dietary Considerations medication in your bloodstream. Adalat CC, Dilacor XR, Cardizem SR and Cardene should be taken on an empty stomach, preferably one Common Side Effects hour before meals or two hours after eating. All others • Nausea can be taken with food or without regards to meals. • Dry mouth and constipation • Dizziness Patients taking Plendil (felodipine) should NOT eat or • Headache drink grapefruits, juice blends containing grapefruit juice, • Loss of appetite or dietary supplements containing grapefruit juice extracts.
Additional Information Some of the extended-release and long-acting brands do not dissolve completely in the stomach. It is possible that you may see the used shell or tablet in your stools. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 58
Diuretics
Uses Diuretics or "water pills" are used primarily to treat conditions such as high blood pressure, congestive heart failure, and fluid retention (edema). They work in the kidney to cause you to urinate more frequently and eliminate excess fluid.
How Should You Take This Dietary Considerations Medication? Spironolactone should be taken with food. Diuretics are usually taken once a day in the morning or twice a day in the morning and afternoon. You will Some diuretics can cause a loss of potassium, while others have to urinate more frequently for several hours after can cause potassium retention. Your physician may each dose. prescribe a diet that is high in potassium rich foods, or taking a potassium supplement. Talk with your physician Common Side Effects before any change in diet or use of a salt substitute. • Dizziness • Dry mouth Additional Information • Muscle weakness Some diuretics can cause sensitivity to sunlight. Wear • Nausea protective clothing or use a sunscreen with a SPF rating • Headache of at least 15 for outdoor activities.
Precautions Contact your physician if you experience any of the following: • Rash • Muscle cramps or fatigue • Irregular pulse or heartbeat Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 59
Potassium Supplements
Uses Potassium is an important electrolyte that is necessary for proper function of your muscles, nerves and heart.
How Should You Take This Dietary Considerations Medication? Most salt substitutes are high in potassium. Consult with Potassium supplements are available as oral tablets, your doctor before starting a salt restricted or "low salt" capsules or liquid and as effervescent tablets and diet. powders that are mixed with juice or beverages. They are usually taken one to four times a day, with meals. Additional Information Take with a full glass of water or beverage. Liquid Some potassium tablets are designed to release potassium potassium supplements should be diluted with 4 or from inside the tablet as it passes through the digestive more ounces of juice or other liquid. tract, while the tablet itself remains intact. It is common to see the tablet shell in your stools. Common Side Effects • Upset stomach • Nausea • Indigestion
Precautions Contact your physician immediately if you experience any of the following: • Mental confusion • Muscle fatigue or cramps • Irregular pulse or heartbeat
Do not take additional non-prescription potassium supplements without talking to your physician. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 60
Anticoagulants (Coumadin)
Uses Coumadin a "blood thinner" is used to prevent your body from making unnecessary blood clots that could block your blood vessels. It works by decreasing the amount of clotting chemicals your body makes.
How Should You Take This Dietary Considerations Medication? Certain foods such as green leafy vegetables, broccoli, Coumadin is taken once a day, usually in the late spinach, kale, brussels sprouts, lettuce and other "greens" afternoon or early evening. It is important to take this are naturally high in Vitamin K, which counteracts the medication the same time each day. If you forget a effects of coumadin. Mayonnaise and vegetable oils are dose and remember later that same evening, take your also high in Vitamin K. You should limit your intake of medication then. If you do not remember until the these foods and be very consistent with your diet. next day, contact your doctor or pharmacist for instructions. If you are not sure if you missed a dose, it Alcohol also thins the blood and increases the effect of is better to skip the dose for the day than to risk the coumadin. You should avoid drinking alcoholic beverages chance of "double dosing". Never skip doses or change while taking coumadin. your dose without consulting your physician. Additional Information Common Side Effects Many medications, both prescription and non- • Headache prescription (over-the-counter) medications interact with • Changes in digestion such as nausea, coumadin. Talk with your doctor or pharmacist before gas and diarrhea taking any new medication, including over-the-counter • Itching medications, vitamins and herbs. Do not take any • Fever prescription or pain medication including aspirin, ibuprofen, naproxyn and acetaminophen(Tylenol) Precautions without first contacting your physician.
Contact your physician immediately if you experience It is advisable to wear a medical alert bracelet or necklace any of the following symptoms: and carry a wallet card that identifies you as taking • Unexplained, or excessive bruising or bleeding coumadin. • Discolored urine (red, brown or dark brown) • Dark or tarry stools • Rash Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 61
Anti-Platelet Medications
Uses Anti-Platelet medications are used to prevent blocked arteries that can result in angina (chest pain), stroke or heart attack. They work by reducing the tendency of certain blood cells to "clump together" and form blockages.
How Should You Take This Dietary Considerations Medication? Persantine (dipyridamole) should be taken on an empty Anti-platelet medications are usually taken once a day stomach either 1 hour before meals or 2 hours after. in the morning. Aspirin and Aggrenox (a combination of aspirin and persantine) should be taken with meals. Common Side Effects • Nausea Additional Information • Diarrhea Do not take additional aspirin, ibuprofen, naproxyn, or • Headache other over-the-counter medications without first talking with your doctor. Precautions Contact your physician immediately if you experience any of the following symptoms: • Unexplained or excessive bruising or bleeding • Discolored urine (red, brown or dark brown) • Dark or tarry stools Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 62
Anti-Arrhythmic Medications
Uses Anti-Arrhythmic medications work in the heart to produce and maintain a regular heartbeat rhythm.
How Should You Take This Dietary Considerations Medication? As a general rule, anti-arrhythmic medications can be Anti-Arrhythmic medications are given once to several taken with food. The most important consideration is to times a day. Once a day medications are usually taken take your medication at the same time every day in in the morning. relation to meals so you can keep a consistent level of the medication in your system. Common Side Effects • Dizziness or lightheadedness Additional Information • Headache Cordarone (amniodarone) may cause sensitivity to • Fatigue sunlight. Wear protective clothing or wear a sunscreen • Changes in digestion such as nausea, and with a SPF rating of at least 15 for outdoor activities. diarrhea or constipation Instructions Precautions If you are not sure if you missed a dose, it is better to skip Contact your physician immediately if you experience the dose for the day than to risk the chance of "double any of the following symptoms dosing". Never skip doses or change your dose without • Angina (Chest pain) consulting your physician. • Shortness of breath or difficulty breathing • Irregular or pounding heartbeat • Signs of infection (fever, chills, muscle aches or sore throat) Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 63
Digoxin (Lanoxin, Lanoxicaps)
Uses Digoxin is most often used to treat congestive heart failure. It works by strengthening the heart muscle to produce a stronger contraction and more regular heartbeat.
How Should You Take This Dietary Considerations Medication? Digoxin can bind with certain foods and other medications. It is best taken on an empty stomach, either Digoxin is usually given once a day, in the morning, or one hour before a meal or 2 hours after eating. once every other day. Food that is high in fiber can decrease the amount of Common Side Effects medication you absorb. Avoid eating high fiber foods or taking bulk laxatives within 2 hours of taking your • Diarrhea medication. • Loss of appetite • Drowsiness, fatigue • Headache Additional Information Your physician may advise you to check your pulse before Precautions taking your medication each day. If your pulse is less than beats per minute, or is irregular, call your physician before Contact your physician if you experience any of the taking that day's dose. following: • Nausea, vomiting, or loss of appetite • Blurred vision or yellow/green halos around objects • Irregular heartbeat • Difficulty in breathing • Fluid retention or weight gain Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 64
Sublingual Nitroglycerin Tablets
Uses Sublingual tablets (tablets that dissolve under the tongue) are used to treat angina (chest pains) when they occur. They are also taken before engaging in strenuous activity to prevent chest pain from occurring. They work by improving blood flow and reducing workload on the heart.
How Should You Take This Precautions Medication? If you have an episode of chest pain while eating, swallow At the first sign of chest pain, sit down and dissolve a any food or drink in your mouth before placing a tablet tablet under your tongue, or between your cheek and under your tongue or between your cheek and gum. If gum. The medication is absorbed from your mouth as you chew tobacco, expel the tobacco before using the the tablet dissolves. It is important NOT to swallow tablets. Just a few sips of drink or a small bite of food will your saliva. Retain the tablet and saliva in your mouth greatly reduce the effectiveness of the medication. as long as possible. If three (3) tablets do not relieve your chest pains and you If the chest pain is not relieved after 5 minutes, you do go to the hospital, do not have anything to eat or can repeat a second tablet. If after 5 more minutes you drink until after the doctor sees you. still have the pain, you can repeat another tablet. If after a total of 3 tablets your chest pain does not go Additional Information away, call an ambulance or have someone drive you Keep a record of your chest pain that includes the time of immediately to the nearest hospital emergency room. day you had the pain, number of tablets required to relieve the pain and the activity that caused or preceded When used to prevent chest pains before engaging in the chest pain. This will help your physician determine strenuous or stressful activity, the tablets should be the best treatment for you. taken at least 10 minutes ahead of time to allow the tablet to dissolve completely and enter your Nitroglycerin tablets should be stored tightly capped in bloodstream. the original glass bottle or a container that is specifically designed for sublingual tablets. Do not carry loose tablets Common Side Effects in your pocket. It is common to experience flushing, dizziness, or Tablets should be replaced 6 months after the bottle has headache when using sublingual nitroglycerin tablets. been opened, even if the tablets appear fresh. You may also experience a slight burning or tingling Nitroglycerin tablets may lose their effectiveness once the sensation in your mouth from the tablets. This is a bottle has been opened. common and harmless side effect. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 65
Quitting the Smoking Habit
Why should I quit smoking? Smoking cigarettes tops the list of major risk factors of our number one killer – heart and blood vessel disease. In fact, almost one-fifth of deaths from heart disease are from smoking. The long list of diseases and deaths due to smoking is frightening. Smoking also harms thousands of nonsmokers who are exposed to cigarette smoke. It causes infections, disease and death in infants and children.
If you smoke, you have good reason to worry about its effect on your health and the health of your loved ones and others. You could become one of the more than 400,000 deaths smoking causes every year.
When you quit, you reduce that risk tremendously!
No one says that quitting cigarettes is easy. But everyone says it’s worth it! Quitting will drastically reduce your risk of heart and blood vessel diseases – diseases that kill someone every 34 seconds. It will also lower your chance of lung disease and cancer. Most of all, quitting can save your life and the lives of nonsmokers around you.
What Follows Your Final Cigarette: 20 Minutes 2 Weeks to 3 Months • Your blood pressure returns to its usual level • Your circulation is better • Your pulse rate slows to normal • Walking is easier for you • Your circulation improves enough to warm your • Lung function increases up to 30 percent hands and feet to normal temperature 1 to 9 Months 4 Hours • You cough less • Half the carbon monoxide from your last cigarette • Your sinuses are clearer has left your bloodstream • You have more energy • You don’t become short of breath as easily 8 Hours • The carbon monoxide from your last cigarette is 1 Year now gone from your bloodstream • Your heart-attack risk has fallen halfway between that • Your blood now carries a normal amount of oxygen of a current smoker and that of someone who has never smoked 24 Hours • Your risk of heart attack is lower 5 Years • Your risk of heart attack and stroke approaches that of 48 Hours a nonsmoker • Damaged nerve endings start to regrow • Your sense of smell and taste have improved 10 to 15 Years • Your risk of dying from any cause is almost the same as that of someone who never smoked Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 66
How Can I Quit Smoking?
How do I quit? Is it too late to quit? No matter how much or how long you’ve smoked, when Step 1 you quit, your risk of heart disease goes down. Three • List reasons to quit and read them daily. years after quitting, your risk of heart disease is almost the • Wrap your cigarette pack with paper and rubber same as if you’d never smoked. That’s like gaining back bands and when you smoke, write down the time the health you almost lost! of day, how you feel, and how important that cigarette is to you (on a scale of 1-5). What happens after I quit? • Rewrap the pack. • Sense of smell and taste come back Step 2 • Smoker’s cough goes away • Keep reading your list of reasons and add to it if • Will digest more normally you can. • Feel alive and full of energy • Don’t carry matches and keep your cigarettes a bit • Breathe much easier out of reach. • Easier to climb stairs • Each day, try to smoke fewer cigarettes, trying not • Feel free from the mess, smell and burns in clothing to smoke the ones that aren’t most important. • Feel free of "needing" cigarettes • Live longer and have less change of heart disease, lung Step 3 disease and cancer • Continue with Step 2 What if I smoke after quitting? • Don’t buy a new pack until you finish the one you’re smoking. It’s hard to stay a nonsmoker once you’ve had a cigarette, • Change brands twice during the week, each time so try everything you can do to avoid that "one." The for a brand lower in tar and nicotine. urge to smoke will pass. The first 2 to 5 minutes will be • Try to stop for 48 hours at one time. the toughest. If you do smoke after quitting:
Step 4 • This doesn’t mean you’re a smoker again – do something now to get back on track. • Quit smoking completely. • Don’t punish yourself – you’re still a nonsmoker. • Increase your physical activity. • Think about why you smoked and decide what to do • Avoid situations you relate with smoking. the next time it comes up. • Find a healthy substitute for smoking. • Sign a contract to stay a nonsmoker. • Do deep breathing exercises when you get the urge. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 67
How Can I Handle the Stress of Not Smoking?
How can I cope with the urge? How can I relax? • Write down the reasons why you quit and look at • Try deep breathing. Take a long, deep breath, count to the list often. 10 and release it. Repeat five times and you’ll feel much more relaxed. • Don’t talk yourself into coming up with a reason to have "just one," stop yourself. Think of what • Use 20 minutes a day to let go of tension this way: triggered you and come up with a different way to Close your eyes, relax your muscles and think hard handle it. For example, if you feel nervous and about one word, like "calm." Say it until you reach a think you need a cigarette, realize that you could state of relaxation. take a walk to calm down instead. • Think positive thoughts! Focus on how great it is that • Be prepared for times when you’ll get the urge. If you’ve stopped smoking, how food tastes better and you smoke when drinking, cut down on alcohol how nice it is not to wake up coughing. Remind so you don’t weaken your promise to yourself. yourself how smoking stinks, stains your teeth and gives you bad breath. • Change your habits. Instead of having a cigarette after dinner, brush your teeth or walk the dog. • Listen to relaxation audiotapes.
• Go where there’s no smoking allowed. In How can exercise help? restaurants ask to be seated in the non-smoking section. • It releases stress. • It calms you down. • Stick around people who don’t smoke. Ask for • It can improve your mood. support and find a buddy you can call when you • keeps your mind off cigarettes. feel weak. Tell others they can help you by not • It can help control your appetite. giving you a cigarette and by being supportive. • It can help you lose weight if you’re overweight or stay • Reward yourself each time you get through a day at a normal weight. or week without smoking. Treat yourself to a movie. Or figure out how much money you’ve saved and buy yourself something special. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 68
How Can I Handle the Stress of Not Smoking? Cont.
What are good activities to help How can I learn more? keep weight off? • Talk to your doctor, nurse or health care professional. Becoming more active can help you reduce or Or call your local American Heart Association at 1- maintain your weight. Try any of the following, but 800-242-8721. check with your doctor first. • If you have heart disease, members of your family also • Walk in your neighborhood or at indoor shopping may be at higher risk. It’s very important for them to malls. make changes now to lower their risk. • Do gardening or yard work. • Take stairs instead of escalators and elevators. Do you have questions or • Park farther from stores and walk. comments for your doctor? • Learn a new dance. • Take a few minutes to write your own questions for • Ride a bicycle. the next time you see your doctor. For example: • Try aerobic dance classes or use a videotape at home. How long will the cravings last? What can I do instead of smoking? What about nicotine gum? • Play with a pencil, paper clip or marbles. How do I read food labels? • Munch on carrots, apples, celery and sugarless gum. • Brush your teeth often and keep a fresh taste in your mouth. • Keep your hands busy – wash the car, garden, knit, do crossword puzzles, write letters, cook. • Try a new sport. • Get plenty of rest and exercise.
What else can I do? • Try relaxation techniques like deep breathing or meditation. • Think positive thoughts! Feel proud about quitting. • Write down why you’re quitting and read it. • Spend time with other nonsmokers. • Go where there’s no smoking, like stores, movies, churches and libraries. • Reward yourself every day or week that you stay a nonsmoker. • Don’t use food as a reward. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 69
Support Group
offering encouragement &
to heart patients... hopefamilies and care givers
Mended Hearts, Inc.
The Mended Hearts, Inc. is a volunteer service and support organization consisting of people who have had heart surgery, angioplasty, heart attacks and other heart conditions. Their spouses, family members, medical professionals and other interested individuals are also involved in this organization.
For more information, call (270) 264-3345 or (812) 925-6894. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 70
Let’s Exercise
The following pages are presented to you and your family to guide your exercise as soon as you are discharged from the hospital. A safe recovery at home includes gaining strength by progressively increasing walking. The walking time and distance will be increased as tolerated on an individual basis.
You will experience days that you feel better than other days. Try to stay within the guidelines provided to help you safely gain strength.
Why Exercise? • You will feel stronger and healthier. • You will be able to control weight. • You will be able to cope with stress a little better. • Your heart will become a better pump.
What Type of Exercise? • One that you will enjoy and will do regularly. • One that is aerobic, like walking. • One you can do continuously for ten or more minutes without problems.
When to Exercise? • 11/2 to 2 hours before a meal. • Before meals. • If you have diabetes, the best time to exercise is one hour after a meal. After breakfast is a great time to exercise.
What to Wear to Exercise? • Comfortable shoes. • Soft absorbent cotton socks. • Loose fitting clothes. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 71
Stretches & Light Exercise
These stretches will help you feel better after your surgery.
Stretching Instructions: • Do daily – especially after exercising • DO NOT HOLD YOUR BREATH • DO NOT Bounce. Use a slow, steady motion. • Hold each stretch for 10-20 seconds. • If the stretch becomes painful - STOP!
Deep Breathe: Shoulder Shrugs:
Purpose: to expand lungs. Purpose: to stretch shoulders & upper back
Starting Position: Standing or sitting. Starting Position: Standing or sitting, arms at your side. Action: Inhale slowly and deeply through your nose to fill your lungs as much as possible. Slowly exhale Action: Slowly raise (shrug) shoulders up toward your through your mouth. Repeat 3–5 times. ears. Hold for five count. Return shoulders and arms to a resting position. Repeat 3–5 times. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 72
Stretches & Light Exercise
Unilateral Shoulder Unilateral Shoulder Extension/Flexion: Rotation:
Purpose: Loosen and stretch shoulders and upper Purpose: to stretch and loosen shoulder, chest and chest. upper back.
Starting Position: Standing or sitting Starting Position: Standing or sitting.
Action: Place your hands on your shoulders. Slowly Action: Place hands on shoulders. Slowly circle right raise one hand up toward the ceiling while exhaling. arm forward 3–5 times, then backward 3–5 times. Raise your hand until a gentle pull is felt and then Start the motion by making small circles and return hand to the starting position. Alternate arms 3 gradually making them larger as is comfortably to 5 times. possible. Repeat with the left arm. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 73
Stretches & Light Exercise
Shoulder Abduction/Adduction: Arm Circles: Purpose: to loosen and rotate the shoulder joint. Purpose: loosen and strengthen shoulders and upper chest. Starting or Sitting Position: Raise your arms out to shoulder level. Starting Position: Standing or sitting, arms down at your side. Action: With your head and neck relaxed, rotate your arms in small circles, first forward and then Action: Starting with arms at your side, raise arms out backward, for 10 to 15 seconds. Rest your arms at to the side and up to your shoulder level. Keep elbows your sides briefly, then repeat. relatively straight. Lower arms down to starting position. Repeat 3–5 times. Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 74
Stretches & Light Exercise
Cardiac Rehabilitation Special Ankle Pumps: Information: Purpose: to stretch ankles and calves. Avoid Exercising in the Heat and Humidity because: Starting Position: Sitting and feet flat on the ground. Your heart has to work to help you cool down. It does Action: Place your heel on the floor with a slight bend this by expanding the blood vessels near the skin’s in your knees. Flex the ankle bringing the toes toward surface. Thus it does not have as much to give to your your face. Hold for a count of 5. Point your toes away muscles. Your blood can not effectively be in two places from your body, raising your heels off of the floor and at once. You cannot exercise as fast or as long as a result. hold again for a 5 count. Repeat 3–5 times. Avoid Exercising in the Cold because: The cold makes blood vessels narrow. The heart then has to pump harder to get the same amount of blood through. This can increase blood pressure. You also can have increased amounts of angina or irregular heart beats. The cold air may constrict airways, making you feel short of breath.
Remember to avoid exercising in temperatures below 40 degrees or above 85 degrees and 70% humidity.
Cardiac Education • (270) 688-5080 • martha.sims@owensboro health Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:57 PM Page 75
Cardiac Rehabilitation After Open Heart Surgery
Open Heart Surgery is Not a Cure for coronary artery disease. As part of your recovery process, it is strongly recommended that you attend a Cardiac Rehabilitation Program to assist you with making positive changes to a healthier lifestyle and assist in your recovery. You will need to discuss with your cardiologist about beginning a Cardiac Rehabilitation Program usually 3-4 weeks after surgery.
A Cardiac Rehabilitation Program Dietary Counseling includes the following: • Heart Healthy Diet (Low Fat, Low Cholesterol, Low Sodium) Heart Monitored Exercise • Weight Control • Pulse and Heart Rhythm Monitoring • Personal Exercise Plan Developed The Cardiac Rehabilitation Team which consists of Registered Nurses, Exercise Physiologist, Dietitian, and Education Physical Therapist teach you and your family how to • Risk Factor Modification cope with cardiac related illness and to maximize your potential at a level that is appropriate for you to return to • High Blood Pressure a productive life. • Diabetes • Smoking Cessation Please contact the Cardiac Rehabilitation Program and • Stress Management they will be glad to answer any questions you may have. • Understanding Heart
Disease and Treatment • How Your Heart Functions • Medications
Cardiac Education • (270) 688-5080 • martha.sims@owensboro health.org Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:58 PM Page 76
Cardiac Rehabilitation
The Cardiac Rehab Program at Owensboro Health is a program designed to help you return to your normal, active life after having a heart attack or surgery. The program is made up of four "phases" as you improve over time. Each phase involves a specific exercise program and special education about how to take care of yourself, all in keeping with your doctor’s plan for you. In addition to assisting you in your recovery, the Cardiac Rehab program can also help you and your family adjust to the changes caused by your heart disease.
Phase 1 While you are exercising, your heart rate and blood Phase 1 begins while you are still in the hospital – pressure will be closely monitored. The staff will teach usually about 24 hours after your condition has you how to watch your heart rate when you are exercising stabilized in the Cardiac Stepdown Unit (CSU). The at home. Phase 2 lasts from two weeks to 12 weeks based staff will encourage low level activities such as some on your needs and the doctor’s plans. The staff will help stretching exercises, help you sit in the chair, and walk you find out about how your own insurance company in the hall. covers this program.
You will also begin to do some of your normal self-care Phase 3 tasks, like feeding yourself, bathing, shaving and hair Phase 3 is a program of exercise at the Healthpark, care. Because the hospital stay is usually short, when located at the Ford Avenue campus. This phase helps you you are ready to go home you will be given some keep your exercise sessions going on a regular basis. Many instructions for routine activity at home and exercises people exercise two or three times a week and also begin you can do to help you get stronger. You will also using other equipment there to increase their strength. begin to learn about the things in your life that put Treatment plans are guided by patient’s goals, needs and you at risk for heart disease and how you can decrease capacities. your risk.
Phase 2 Phase 4 Phase 2 usually begins within about four weeks of your Phase 4 is also located at the Healthpark and is designed going home from the hospital. You will come to the as a maintenance program. It can also be used by other Owensboro Health Regional Heart and Lung Rehab members of the family to help reduce their risk factors, to for exercise and educational classes three times a week feel better, and have greater physical capacities. for sessions that are designed for you and your specific needs. While the emphasis in on aerobic activities, it We encourage you to invite your spouse or other family may also include muscle strengthening and flexibility. members to join us in this exercise program as well, Classes include topics like the Cardiac Diet, How to because regular exercise can help them to become Deal with Stress, Relaxation and How to Keep a healthier, too. From time to time, there may also be Healthy Lifestyle. special events at the Healthpark that provide you with more support for the things you have learned.
Cardiac Education • (270) 688-5080 • martha.sims@owensboro health.o Open Heart Binder 2015 No Tabs.qxp_OpenHeart Insert Pre-Op(14-60) 5/18/15 2:58 PM Page 77
Advance Directive Case Law
DeGrella, By and Through Parent, v. Elston, Ky., 858 S.W. 2nd 698 (1993)
In the DeGrella decision cited above, the Kentucky Supreme Court held that artificial life- sustaining medical treatment, including nutrition and hydration, could be withdrawn from a patient in a persistent vegetative state through a surrogate decision-making process if there is a clear and convincing evidence that such a withdrawal was the wish of the patient as previously expressed by the patient while competent. The court also held that legal action would not be required to authorize the discontinuance of artificial-sustaining medical treatment if the attending physician, hospital or nursing home ethics committee where the patient resides, and legal guardian or next of kin all agree and document the patient’s wishes and the patient’s condition. However, the parties who participate in making the decision will not be absolved from liability if the facts do not exist to support the decision.
For your information this is provided to you in compliance with Federal and State law.